Baroreflex function and postprandial hypotension in older adults

Abstract

Purpose Postprandial hypotension (PPH) is a common but poorly understood etiology for fainting in older adults. One potential mechanism is age-related baroreflex dysfunction. We examined baroreflex function in older adults with PPH and without PPH (noPPH) during a standardized meal test. Methods 57 adults (age ≥ 65; 24 PPH, 33 noPPH, mean age 77.9 ± 0.9 years, 54% female) were recruited and had meal tests performed. The baroreflex effectiveness index (BEI, %) and baroreflex sensitivity (BRS, ms/mm Hg) were calculated using the sequence method. Results Baseline BEI (22 ± 2 versus 23 ± 2 percent, t = − 0.411, p = 0.682) and BRS (14.1 ± 2.4 versus 13.8 ± 2.5 ms/mm of Hg, t = − 0.084, p = 0.933) were similar in PPH and noPPH subjects. During the meal test PPH subjects showed significantly lower BEI as compared to noPPH subjects (time × PPH, F = 2.791, p = 0.042), while there was no difference in the postprandial change in BRS (time, F = 0.618, p = 0.605). Conclusion Patients with PPH demonstrated an acute postprandial decrease in baroreflex effectiveness during meal testing as compared with normal subjects, suggesting a potential contributing mechanism for this condition.

Non‐pharmacological interventions for older adults with postprandial hypotension: A scoping review

“…This scoping review included only older adults with PPH, while those without PPH who showed a slight decrease in postprandial SBP were excluded. Previous studies reported that the maximal reduction in postprandial SBP in older adults with PPH, ranging from 46 to 56 mmHg, was significantly greater than that in the no‐PPH group (<20 mmHg; Madden et al, 2021; Schoevaerdts et al, 2019). In identifying the scope of the studies available regarding this topic and research gaps, older adults were defined as the mean or median age of participants aged 60 years or older.…”

“…However, five of the nine included studies set up postprandial BP monitoring time intervals ≥ 15 min, which may have reduced the reliability of the study results, as the duration of postprandial SBP decline >20 mmHg in 25% of older adults with PPH could only continue for 2–8 min (Van Orshoven et al, 2010). Additionally, the average number of PPH events was 3.6–6.2 times after eating (Madden et al, 2021), which meant that postprandial BP decrease in older adults with PPH showed not a single trough but multiple peaks and troughs (Madden et al, 2021; Van Orshoven et al, 2010), varying from a drop of 74 mmHg to an increase of 54 mmHg (Lubart et al, 2006). Considering the properties of PPH, if the postprandial BP monitoring time interval is too long and the postprandial BP monitoring period is too short, it may not be possible to distinguish the differences between the effects on the groups (or conditions) caused by experimental intervention effects or other factors.…”

Association between preoperative autonomic nervous system function and post-induction hypotension in elderly patients: a protocol for a cohort study

“…BRS will be obtained by calculating the slope of the regression line relating changes in SBP to changes in RR interval. Baroreflex Effectiveness Index (BEI) will be defined as the percentage of progressive increase/decrease swings in SBP that are effectively regulated by heart rate, that is, RR interval changes 33. We define the increase in RR interval with rising SBP as BRS+/BEI+, and vice versa as BRS−/BEI−.…”

Pure Autonomic Failure-A Localized Alpha Synucleinopathy with a Potential for Conversion to More Extensive Alpha Synucleinopathies

“…Simple leg crossing alone can increase the BP by 20 mmHg. [ 33 ] Compression stockings and abdominal binders can also be very helpful to prevent OH. Abdominal binders exert 30–40 mmHg pressure on the splanchnic circulation, which may contain up to 25% of total blood volume at rest.…”