title: Postprandial systolic blood pressure responses of older people in residential care: association with risk of falling.
abstract: BACKGROUND
  The association between postprandial blood pressure, falls and medications is controversial.
  
  
  OBJECTIVE
  To investigate cardiovascular responses to meals in elderly people together with clinical associations and therapeutic issues.
  
  
  METHODS
  A cross-sectional observational study of 179 semi-independent older people (age 83.2 +/- 7.0 years) in residential care facilities was undertaken. Data on the frequency of falls, medical and medication history and measurement of blood pressure before and after a breakfast meal, and then after standing and walking after the meal were documented.
  
  
  RESULTS
  Postprandial hypotension (>/=20 mm Hg fall in systolic blood pressure (SBP)) and low absolute SBP (</=115 mm Hg) were common after meals and exacerbated by standing. Risk factors for low postprandial SBP included use of selective serotonin reuptake inhibitors (OR = 4.3, CI 1.4-13.1, p = 0.006), antipsychotic medications (OR = 5.2, CI 1.4-19.2, p = 0.007) and a history of smoking (OR = 4.7, CI 1.5-14.9, p = 0.005). Antihypertensive therapy ameliorated the postprandial decline in blood pressure. The incidence of falls was increased only in the 10% of subjects with low postprandial SBP.
  
  
  CONCLUSIONS
  Significant adverse cardiovascular change is common after meals in older people and a postprandial SBP of <115 mm Hg was associated with a history of falls. Selective serotonin reuptake inhibitors and antipsychotic medications were associated with low postprandial SBP, which may provide a mechanism for their association with falls. Hypertension was positively and antihypertensive therapy negatively associated with postprandial hypotension.
authors.affiliation: Centre for Education and Research on Ageing, University of Sydney and Concord RG Hospital, Concord, NSW, Australia.
authors.forename: David G
authors.initials: DG
authors.lastname: Le Couteur
authors.forename: Alex A
authors.initials: AA
authors.lastname: Fisher
authors.forename: Michael W
authors.initials: MW
authors.lastname: Davis
authors.forename: Allan J
authors.initials: AJ
authors.lastname: McLean
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000097:blood*; D001794:Blood Pressure; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D009735:Nursing Homes; D019518:Postprandial Period; D012307:Risk Factors; D013599:Systole