title: The association between time since last meal and blood pressure in older adults: the cardiovascular health study.
abstract: OBJECTIVE
  To demonstrate a postprandial hypotensive (PPH) phenomenon in older adults.
  
  
  METHODS
  Observational, prospective cohort study composed of baseline and nine follow-up visits.
  
  
  METHODS
  Cardiovascular Health Study, an epidemiological study of risk factors for cardiovascular disease in older adults.
  
  
  METHODS
  Five thousand eight hundred eighty-eight community-dwelling adults aged 65 and older.
  
  
  METHODS
  Blood pressure and time since last meal were recorded synchronously at baseline and at follow-up clinic visits. Generalized estimating equations were used to estimate associations between time since last meal and blood pressure and to adjust variance estimates to account for repeated blood pressure measures within subjects across fasting times.
  
  
  RESULTS
  Mean systolic and diastolic blood pressures were lower in the first hour after the last meal and were progressively higher through the fourth hour after the last meal than blood pressures measured immediately after the last meal (0 hour: 133.7/68.8 mmHg; 1st hour: 130.1/66.6 mmHg; 4th hour: 136.5/71.1 mmHg). Changes were significant for systolic and diastolic measures (P <.001 for both). Exploratory analyses suggested that the systolic PPH association was more pronounced in women. Little evidence was found that the degree of systolic or diastolic PPH varied by age, race, prevalent cardiovascular disease, heart rate, ejection fraction, treated hypertension or diabetes mellitus, or body mass index.
  
  
  CONCLUSIONS
  These data support previous observations that there is a significant drop in blood pressure within 1 hour after a meal in older adults. Time since last meal may be an important factor to consider when measuring blood pressure in older adults, and perhaps national standards need to be set.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, Washington, USA. nlsmith@u.washington.edu
authors.forename: Nicholas L
authors.initials: NL
authors.lastname: Smith
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.forename: Gale H
authors.initials: GH
authors.lastname: Rutan
authors.forename: Thomas
authors.initials: T
authors.lastname: Lumley
authors.forename: David
authors.initials: D
authors.lastname: Yanez
authors.forename: Paulo H M
authors.initials: PH
authors.lastname: Chaves
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kronmal
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000503:physiopathology; D015331:Cohort Studies; D004435:Eating / Q000502:physiology*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000503:physiopathology*; D008297:Male; D019518:Postprandial Period / Q000502:physiology*; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors