Upright posture and postprandial hypotension in elderly persons.
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.


METHODS
Controlled paired comparison.


METHODS
Clinical research center.


METHODS
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.


METHODS
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.
Maurer
M S
MS
Division of Circulatory Physiology, College of Physicians and Surgeons, Columbia University, 177 Fort Washington Avenue, MHB 5-435, New York, NY 10032, USA. msm10@columbia.edu
Karmally
W
W
Rivadeneira
H
H
Parides
M K
MK
Bloomfield
D M
DM
D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000209:etiology* / Q000503:physiopathology; D007024:Hypotension, Orthostatic / Q000209:etiology* / Q000503:physiopathology; D008875:Middle Aged; D019518:Postprandial Period; D013575:Syncope / Q000209:etiology; D018667:Tilt-Table Test