Postprandial hypotension as a risk marker for asymptomatic lacunar infarction.
OBJECTIVE
Increasing blood pressure (BP) variability is reported to be a cardiovascular risk factor. However, the clinical implications of postprandial hypotension (PHYPO), a commonly observed BP variability in elderly persons, are poorly understood. Here, we investigated the possible associations between postprandial BP decline and asymptomatic cerebral damage in community residents.


METHODS
Study participants consisted of 1308 general community residents (65 ± 9 years old). Postprandial BP change was calculated from SBP measured just before and 30 min after lunch. PHYPO was defined as a decline in SBP of more than 20 mmHg. The presence of asymptomatic cerebrovascular damage was evaluated by brain MRI.


RESULTS
Prevalence of lacunar infarction was significantly higher in participants with PHYPO (P = 0.004). A postprandial decline in SBP was linearly increased with the number of lacunar lesions (none, n = 1200, -3.4± 11.3 mmHg; one lesion, n = 82, -5.2 ± 11.8; two lesions, n = 18, -6.9 ± 11.5; three lesions, n = 7, -13.4 ± 11.3; and four lesions, n = 1, -27; P = 0.012). Although participants with PHYPO were older (P < 0.001) and had higher preprandial BP (P < 0.001) and faster pulse wave velocity (P = 0.001), multivariate analysis adjusted for these covariates indicated that postprandial BP decline was an independent determinant for the number of lacunar infarctions (P = 0.004). No significant associations were observed with grade of periventricular hyperintensity or frequency of microbleeds. These relationships were also found in an analysis based on central BP, whereas no superiority was seen in the analysis based on central BP.


CONCLUSIONS
Postprandial BP decline is an overlooked risk marker for asymptomatic lacunar infarction in community residents.
aCenter for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto bDepartment of Geriatric Medicine, Ehime University Graduate School of Medicine, Ehime, Japan.
Yasuharu
Y
Tabara
Yoko
Y
Okada
Eri
E
Uetani
Tokihisa
T
Nagai
Michiya
M
Igase
Tomoko
T
Kido
Namiko
N
Ochi
Maya
M
Ohara
Rie
R
Takita
Katsuhiko
K
Kohara
Tetsuro
T
Miki
D000368:Aged; D015415:Biomarkers / Q000378:metabolism*; D001794:Blood Pressure; D005260:Female; D006801:Humans; D007022:Hypotension / Q000453:epidemiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period; D012307:Risk Factors; D059409:Stroke, Lacunar / Q000378:metabolism*
D015415:Biomarkers