0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Brief Communications |

Upright Posture and Postprandial Hypotension in Elderly Persons

Mathew S. Maurer, MD; Wahida Karmally, MS, RD, CDE; Harold Rivadeneira, BS; Michael K. Parides, PhD; and Daniel M. Bloomfield, MD
[+] Article and Author Information

Copyright ©2004 by the American College of Physicians


Ann Intern Med. 2000;133(7):533-536. doi:10.7326/0003-4819-133-7-200010030-00012
Text Size: A A A

Background: Syncope and falls are common in elderly persons and often result from the interaction of multiple clinical abnormalities. Both orthostatic hypotension and postprandial hypotension increase in prevalence with age.

Objective: To determine whether meal ingestion enhances orthostatic hypotension in elderly persons.

Design: Controlled paired comparison.

Setting: Clinical research center.

Patients: 50 functionally independent elderly persons recruited from local senior centers (n = 47) and from patients hospitalized with an unexplained fall or syncope (n = 3) (mean age, 78 years [range, 61 to 96 years]). Twenty-five participants (50%) were taking antihypertensive medication.

Measurements: Sequential head-up tilt-table testing at 60 degrees was performed before and 30 minutes after ingestion of a standardized warm liquid meal that was high in carbohydrates. Heart rate and blood pressure were continuously monitored.

Results: Meal ingestion (P < 0.01) and time spent upright (P < 0.001) were significantly associated with systolic blood pressure, but no significant interaction was found between meal ingestion and time spent upright (P > 0.2). These findings suggest that the association between meal ingestion and head-up tilt-table testing were additive and not synergistic. However, the proportion of participants with symptomatic hypotension increased during head-up tilt-table testing after meal ingestion (12% during preprandial testing and 22% during postprandial testing). Symptomatic hypotension tended to occur more often and sooner after meal ingestion than before meal ingestion (P = 0.03).

Conclusions: Meal ingestion and head-up tilt-table testing are associated with increasing occurrences of symptomatic hypotension. After meal ingestion and head-up tilt-table testing, 22% of functionally independent elderly persons had symptomatic hypotension.

Figures

Grahic Jump Location
Figure 1.
Average change in systolic blood pressure during preprandial (circles) and postprandial (squares) tilt-table testing in 50 study participants.PPP

The figure underestimates the associations of meal ingestion with decrease in blood pressure because participants in whom tilt-table testing was prematurely terminated as a result of severe hypotension are not included in the later stages of the tilt analysis. Associations were found between systolic blood pressure and time spent upright ( < 0.001) and meal ingestion ( < 0.01), but no interaction was found between meal ingestion and time spent upright ( > 0.2).

Grahic Jump Location
Grahic Jump Location
Figure 2.
Association between meal ingestion and time to symptomatic hypotension.

An increased percentage of the same participants had symptomatic hypotension after meal ingestion. The solid line represents preprandial data and the dotted line represents postprandial data. The percentage of participants with a positive result on tilt-table testing was higher after meal ingestion ( = 0.03).

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Blood Pressure in Older Adults after Meals and Standing Up

Copyright ©2004 by the American College of Physicians

Read More...

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)