Ambulatory blood pressure monitoring and postprandial hypotension in elderly patients with isolated systolic hypertension

Grodzicki, Tomasz; Rajzer, Marek; Fagard, Robert; O’Brien, E; Thijs, L; Clément, Denis; Davidson, Christopher; Palatini, P; Parati, Gianfranco; Kocemba, J; Staessen, J. A.

doi:10.1038/sj.jhh.1000573

Cited by 47 publications

(38 citation statements)

References 11 publications

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“…When we examined postprandial hypotension in terms of the magnitude of the fall in SBP, we showed that the SBP dropped by 16 B 21 mm Hg in hostel residents after a meal. This compares with values of 11 B 9 [11], 24 B 9 [14], 22 B 5 [15] and 11 mm Hg [12] in healthy elderly subjects, 6.6 mm Hg in elderly community subjects with hypertension [16], and 18 B 16 [3] and 15 B 2 mm Hg [14] in nursing home residents.…”

Section: Discussionmentioning

confidence: 99%

Postprandial Systolic Blood Pressure Responses of Older People in Residential Care: Association with Risk of Falling

et al. 2003

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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.

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Section: Discussionmentioning

confidence: 99%

Postprandial Systolic Blood Pressure Responses of Older People in Residential Care: Association with Risk of Falling

et al. 2003

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“…This pattern is important to identify so that treatment can be tailored to take account of the fluctuations in blood pressure. In general, older patients are prone to develop hypotension, which may be postural or postprandial112 113in nature, may be caused by baroreceptor dysfunction or autonomic failure,114 or may be the consequence of the greater susceptibility of elderly people to the adverse effects of drugs to lower blood pressure. The identification of symptomatic hypotension constitutes a priviliged indication for the clinical use of ambulatory monitoring in elderly people (table 3).…”

Section: Management Of Hypertension In Special Groupsmentioning

confidence: 99%

Modern approaches to blood pressure measurement

Staessen¹,

O’Brien²,

Thijs³

et al. 2000

Occup Environ Med

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Automated BP measurement is most useful to identify patients with white coat hypertension. Whether or not white coat hypertension predisposes to sustained hypertension remains debated. However, outcome is better correlated with the ambulatory BP than with the conventional BP. In patients with white coat hypertension, antihypertensive drugs lower the BP in the clinic, but not the ambulatory BP, and also do not improve prognosis. Ambulatory BP monitoring is also better than conventional BP measurement in assessing the eVects of treatment. Ambulatory BP monitoring is necessary to diagnose nocturnal hypertension and is especially indicated in patients with borderline hypertension, elderly patients, pregnant women, patients with treatment resistant hypertension, and also in patients with symptoms suggestive of hypotension. Conclusions-The newer techniques of BP measurement are now well established in clinical research, for diagnosis in clinical practice, and will increasingly make their appearance in occupational and environmental medicine.

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“…The prevalence of postprandial hypotension is increased in people who are hypertensive [1,19,38], including those with isolated systolic hypertension [61]. It has been suggested that in hypertensive patients, the increase in splanchnic blood flow after a meal is less effectively counterbalanced as a result of diminished baroreceptor function [19,61].…”

Section: Factors Influencing Postprandial Blood Pressurementioning

confidence: 99%

Postprandial Hypotension - Novel Insights into Pathophysiology and Therapeutic Implications

Gentilcore¹,

Jones²,

O’Donovan³

et al. 2006

CVP

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Postprandial hypotension is a frequent disorder, occurring in approximately 40% of nursing-home residents, and represents a major cause of morbidity and mortality. Current approaches to management are suboptimal. While it has been generally assumed that ingestion of carbohydrate has the greatest effect, the fall in blood pressure (BP) does not appear to be mediated by the consequent elevations in blood glucose and insulin. Moreover, there is evidence that fat may decrease BP to a comparable extent to carbohydrate, although onset of the response may be slower, and that the response is affected by the type of carbohydrate. It has recently been established that the rate of nutrient delivery from the stomach into the small intestine is an important determinant of the hypotensive response to carbohydrate, so that the magnitude of the fall in BP and rise in heart rate is greater when gastric emptying is relatively more rapid. In both healthy elderly subjects and patients with type 2 diabetes, the fall in BP is attenuated when gastric emptying and small intestinal carbohydrate absorption are slowed by dietary (e.g. guar) or pharmacological (e.g. acarbose) means. Conversely, gastric distension attenuates the postprandial fall in BP. Strategies for the treatment of postprandial hypotension should, therefore, potentially be directed at (i) meal composition, particularly carbohydrate type and content, (ii) slowing gastric emptying and/or small intestinal carbohydrate absorption and/or (iii) increasing postprandial gastric distension.

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Ambulatory blood pressure monitoring and postprandial hypotension in elderly patients with isolated systolic hypertension

Cited by 47 publications

References 11 publications

Postprandial Systolic Blood Pressure Responses of Older People in Residential Care: Association with Risk of Falling

Postprandial Systolic Blood Pressure Responses of Older People in Residential Care: Association with Risk of Falling

Modern approaches to blood pressure measurement

Postprandial Hypotension - Novel Insights into Pathophysiology and Therapeutic Implications

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