Intraindividual reproducibility of postprandial hypotension.
BACKGROUND
Postprandial hypotension (PPH) is increasingly recognized as a common cause of falls and syncopes in the elderly. The diagnosis of PPH is based on the measurement of meal-induced blood pressure (BP) changes. Although the problem of intraindividual reproducibility of PPH is of clinical importance, it has not been extensively studied.


OBJECTIVE
To assess the intraindividual reproducibility of PPH.


METHODS
50 patients (42 women and 8 males, 83 +/- 8 years) were included in the study. To evaluate PPH, we measured the BP before and every 15 min for 2 h after the start of a standardized mixed meal. The PPH was defined as a decrease in systolic BP of 20 mm Hg or more. Three sets of BP were obtained for each subject on 2 successive days: (1) between 08.00 and 10.00 h and (2) between 16.00 and 18.00 h on the 1st day and (3) between 08.00 and 10.00 h on the 2nd day.


RESULTS
32 participants (64%) experienced PPH on at least one test. Among them, 19 (38%) had PPH on the first test, 16 (32%) had PPH on the second test, and 21 (42%) had PPH on the third test. The intraindividual reproducibility of PPH was good when the results of the two morning tests were compared together (kappa coefficient = 0.6), but was low when the morning test results were compared with the afternoon test results of the 1st day (kappa coefficient = 0.1).


CONCLUSIONS
Because of the good reproducibility of postprandial BP changes, we conclude that the diagnosis of PPH may be based on a single standardized test. However, the test must be performed under circumstances (time of the meal, medications) similar to those in which the symptoms occurred.
Puisieux
François
F
Service de Médecine Interne et Gériatrie, CHRU Lille, France. f-puisieux@chru-lille.fr
Court
Dominique
D
Baheu
Eddy
E
Dipompeo
Christophe
C
Bulckaen
Hélène
H
Dewailly
Philippe
P
D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D004032:Diet; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D019518:Postprandial Period / Q000502:physiology*; D015995:Prevalence; D015203:Reproducibility of Results; D013575:Syncope / Q000209:etiology