Elderly: post-prandial hypotension was common.

Clinical bottom line (level 1b)

Post-prandial hypotension occurred in a third of elderly patients, living in institutions and who were debilitated medically, functionally and cognitively.
Around 1% became symptomatic from this. Post-prandial hypotension may predispose patients to syncope and falls.

Vaitkevicius et al: Annals of Internal Medicine 1991; 115 (11): 865-870

Expires October 2004

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: nursing home, USA

113 patients (aged range 65 to 96 years; mean 78, 73% female) chronic medical disease or dementia

Excluded if

evidence of dehydration

unable to measure systolic blood pressure

uncooperative

Patients received a standardised meal in a quiet environment at 23 ° C. Seven refused meals and acted as controls

Multiple regression for risk factors for post-prandial hypotension: higher premeal systolic blood pressure; dependent posture during measurement; use of arterial vasodilator; history of syncope

Outcomes studied:

Patients had automated blood pressure measurements every 15 minutes for 90 minutes.

The evidence

mean systolic fall in blood pressure - 17.9 +/- 15.5 (range +26 to -64 mmHg). No change noted in controls.
36% had a fall > 20 mmHg - two with symptoms (one angina attack, one TIA).
no difference noted in mortality between patients with severe post-prandial hypotension and those without (very small study)

Comments

Possible risk factor for syncope in elderly patients?

Citation

Vaitkevicius PV, Esserwein DM, Maynard AK, et al: frequency and importance of postprandial blood pressure reduction in elderly nursing-home patients. Annals of Internal Medicine 1991; 115 (11): 865-870

Contributor: Chris Ball and Clare Wotton, October 2000
Reviewer: Malcolm Man-Son-Hing

_{Clinical Question.}

_Patient	_elderly
_{Intervention or Exposure}	_prevalence
_Outcome	_{post-prandial hypotension}