title: Ambulatory blood pressure monitoring and postprandial hypotension in elderly persons with falls or syncopes.
abstract: BACKGROUND
  Postprandial hypotension (PPH) is increasingly recognized as a common cause of falls and syncope in elderly persons. Noninvasive ambulatory blood pressure monitoring (ABPM) has been recommended for detecting PPH. This study investigates postprandial blood pressure (BP) changes by means of ABPM in elderly patients experiencing falls or syncopes.
  
  
  METHODS
  Twenty-four-hour ABPM was performed in 156 inpatients (111 women, mean age 80.4 +/- 8.1 years). Among them, 45 had been admitted for falls and 75 for syncope; 36 with no history of falls or syncope served as controls. Postprandial change in systolic blood pressure (deltaSBP) was calculated by subtracting the mean SBP within the 2 hours following the meal from the mean SBP within the 2 hours preceding the meal. PPH was defined by a deltaSBP > or = 20 mm Hg.
  
  
  RESULTS
  For the entire group, mean SBP decreased after the three meals. On average, the decline in SBP was greater after breakfast than after lunch or dinner, and the number of patients experiencing PPH was greater after breakfast. Average maximal deltaSBP was significantly larger in the syncope group than in the other groups ( p < .05). Moreover, the number of patients experiencing PPH was significantly higher in the syncope/fall group than in the control group (23% vs 9%; p = .03). Compared with patients without PPH, patients with PPH were more likely to have a history of diabetes mellitus (p < .01) or to use more than three different drugs daily ( p = .04), and they showed greater daytime SBP variability (p < .0001). Furthermore, there was a strong positive correlation between preprandial SBP and deltaSBP after breakfast.
  
  
  CONCLUSIONS
  About one out of four elderly patients with falls or syncope experiences PPH, usually after breakfast. Postprandial decline in BP contributes to BP variability. deltaSBP and preprandial SBP are positively correlated.
authors.affiliation: Department of Internal Medicine and Geriatrics, Hôpital Gériatrique les Bateliers, Centre Hospitalier Régional, and University of Lille, France. fpuisieux@nordnet.fr
authors.forename: F
authors.initials: F
authors.lastname: Puisieux
authors.forename: H
authors.initials: H
authors.lastname: Bulckaen
authors.forename: A L
authors.initials: AL
authors.lastname: Fauchais
authors.forename: S
authors.initials: S
authors.lastname: Drumez
authors.forename: F
authors.initials: F
authors.lastname: Salomez-Granier
authors.forename: P
authors.initials: P
authors.lastname: Dewailly
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D016009:Chi-Square Distribution; D002940:Circadian Rhythm; D048909:Diabetes Complications; D004435:Eating / Q000502:physiology*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D019338:Polypharmacy; D013575:Syncope / Q000209:etiology* / Q000503:physiopathology; D013599:Systole; D013997:Time Factors