title: Meal-induced blood pressure variation and cardiovascular mortality in ambulatory hypertensive elderly patients:  preliminary results.
abstract: OBJECTIVE
  This prospective cohort study was designed to investigate the prevalence and the prognostic value of postprandial hypotension (PPH) in ambulatory hypertensive elderly patients without overt heart diseases, an issue that has never been evaluated so far.
  
  
  METHODS
  All patients consecutively referred to our cardiologic clinic in the period from January 2005 to August 2009, were enrolled in the study and underwent a 24-h ambulatory arterial blood pressure monitoring (ABPM). PPH has been defined as a decrease in SBP of 20  mmHg within 2  h after a meal.
  
  
  RESULTS
  Four hundred and one patients were enrolled (mean age 77.7  ±  11 years, males 47.7%). Hypertension was not adequately controlled in 290 (72.3%) patients. PPH was found in 292 of 401 (72.8%) patients. A value of 10  mmHg or higher of SD SBP was predictive of PPH, with a sensitivity and specificity of 87 and 57%, respectively. At each meal, patients with higher SBP readings before meal had the greatest decrease in SBP (P  <  0.001). During the follow-up, 34 patients died for cardiovascular causes. Breakfast BP variation was the most predictive variable of cardiovascular mortality (B  =  0.020, P  =  0.04, HR 1.020, IC 1.001-1.040).
  
  
  CONCLUSIONS
  In our population, PPH was common. A diurnal standard deviation of SBP of 10  mmHg or higher was suggestive of its presence. ABPM identified breakfast BP decrease as a possible new risk factor for cardiovascular mortality.
authors.affiliation: Division of Geriatric Medicine, University of Modena and Reggio Emilia, Modena, Italy. andrea.zanasi@hotmail.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Zanasi
authors.forename: Enrico
authors.initials: E
authors.lastname: Tincani
authors.forename: Valeria
authors.initials: V
authors.lastname: Evandri
authors.forename: Paolo
authors.initials: P
authors.lastname: Giovanardi
authors.forename: Marco
authors.initials: M
authors.lastname: Bertolotti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rioli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D062408:Breakfast; D002318:Cardiovascular Diseases / Q000401:mortality / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology*; D007558:Italy / Q000453:epidemiology; D008297:Male; D062407:Meals; D019518:Postprandial Period / Q000502:physiology*; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors