Am J Med. Mar;(3)e doi: / Postprandial hypotension. Luciano GL(1), Brennan MJ, Rothberg MB. Define postprandial hypotension. postprandial hypotension synonyms, postprandial hypotension n hipotensión f orthostatic — hipotensión ortostática. A related problem, postprandial hypotension, is common in older patients and those with autonomic dysfunction. In postprandial hypotension.
|Published (Last):||10 September 2004|
|PDF File Size:||17.66 Mb|
|ePub File Size:||3.93 Mb|
|Price:||Free* [*Free Regsitration Required]|
Alvarez de la Cadena d. Postprandial hypotension is a known cause of syncope in the elderly. Its prevalence is unknown in our country. A prospective cross-sectional study was performed to determine PPH’s Prevalence in elderly adults of both an urban and a rural Community in the State of Queretaro. Blood pressure measurements included a basal pre-prandial record, minute 0 recording at the moment they finished the meal and every 10 min until a 90 min record was complete.
We included a medical history, a mental state test for cognitive evaluation Minimental and Minnesota Quality of life score and a food macronutrient composition analysis. We included subjects, Two-hundred and five subjects Post-prandial hypotension is a common finding postorandial this elderly population.
We did not find distinctive conditions or markers that allow identification of subjects at risk for postprandial hypotension and its complications. This should prompt for routine screenings in specialized facilities to prevent complications.
Se incluyeron sujetos de En sujetos Un grupo de 66 pacientes Esto puede suponer una necesidad de ihpotension rutinario para prevenir complicaciones. Postpransial is a common finding among elderly people. There are many causes for syncope in the elderly and it is common that several of them co-exist in the same person. These include arrhythmias, heart disease, medication-related syncope, and autonomic dysfunction such as neurally mediated syncope and orthostatic hypotension as well as postprandial hypotension PPH.
Post-prandial hypotension is presumed hipotejsion be a common issue related to syncope in the elderly but it has nipotension scarcely studied in our country.
Eight percent of the syncope events in that population are possibly caused by PPH.
Several factors contribute to the presence of PPH. The aging process could partially explain the abnormal autonomic blood flow regulation to the splanchnic vessels during the digestion process.
Such changes induce vasodilatation, reduce the heart’s filling pressure and thus cardiac output, originating PPH and syncope. The gastric emptying rate is another determinant of the plasma glucose levels after a meal that can influence the cardiovascular response to glucose concentrations. Most patients with PPH are asymptomatic but sometimes unspecific symptoms such as dizziness, weakness, nausea, chest pain or palpitations suggest PPH before serious complications, as syncope and acute heart or cerebral ischemia, appear.
To our knowledge, no study has been made to evaluate HPP’s prevalence in our country. Since the elderly population is growing, these issues should be addressed to establish the higher risk profiles or to help defining safety policies. The present study was designed to determine the prevalence of PPH in this population, as well as its relations with other conditions, medications, type of macronutrients and its impact on quality of life and mental status.
A prospective cross-sectional study to evaluate the prevalence of PPH among elderly subjects in retirement homes “institutionalized” and in their family home was conducted. The study included people from two retirement homes in the city of Queretaro and a rural community in the municipality of Ezequiel Montes, Queretaro. In order to identify possible associations with medical history, diet components and changes in mental status and quality of life, several tests were made.
In a first meeting, the patients were told about the study goals and the need to obtain blood pressure records every 10 min for 90 min after breakfast and lunch. If they accepted, they were given an informed consent form and we obtained their medical history, medications, history of syncope or fainting and chronic illnesses.
A minimental test and a Minnesota Quality of life test were included in this main clinical evaluation. Once the history was hipotensino, we could start with blood pressure measurements every ten minutes the same day at lunch time or the next day during breakfast and potsprandial time. We included all the elderly subjects living at their family home or institutionalized that voluntarily wished to participate and were in a stable chronic condition.
We eliminated from the analysis the subjects 4 that did not complete the required min measurements for other reasons than symptoms. People with known PPH or any other acute illness, as well as special care needs enteral nutrition through catheters for example were not included in the sample. Post-prandial hypotension was defined as a reduction of 20 mmHg or more for the systolic postprandiak pressure BP reading and 10 mmHg or more for the diastolic one, in both cases compared to the baseline postpramdial preprandial.
We considered that PPH was “significant” when BP dropped below mmHg for the systolic value and below 60 mmHg for the diastolic one or if the systolic BP drop was superior to 40 mmHg or if the diastolic BP fell more than 20 mmHg and was symptom-related. All blood pressure recordings were postprandiap by one of the investigators and at least one certified nurse with a calibrated device and a standardized measurement technique.
The BP measurements were performed after breakfast and lunch that in Mexico are traditionally the most important meals of the day. The basal BP record was obtained after at least a five-minute rest period in a sitting position prior to the meal studied.
Immediately after the patient finished his last dish, we recorded the “minute 0” reading and from that moment, every 10 min BP was measured for a 90 min period. During the main interview, the patients had to perform a minimental test and a Minnesota quality of life interview, as was done in a previous work. While the patient was having breakfast and lunch, we recorded the sort of meal they were having and its amount in standardized posttprandial such as “one cup” for volumes coffee, milk, main course of meat or pasta or cooked vegetables or “one posstprandial for fruits or bread.
A nutritionist analyzed all the registered meals to define the macronutrients composition of each one. We obtained the amount in grams of carbohydrates, lipids and proteins according to the standardized Mexican tables and calculated the percentage of each macronutrient included in every analyzed meal. Comparisons between groups were made with T test and X 2.
We also performed a logistic regression analysis to determine if there were possible associations. We performed hipotenslon first analysis with all the patients that showed PPH diagnostic criteria after any of the meals observed, a second analysis for people that had PPH after both meals, and finally, for patients that showed significant BP reductions after both meals, that is, systolic recordings below mmHg and diastolic under post;randial mmHg or that had a reduction in systolic values beyond 40 mmHg and 20 mmHg hipoetnsion the diastolic ones.
A last comparison was made for people living in their family home against people living in elderly-care institutions. During a six-month period we recruited elderly people.
Sixty of them declined participation, and after the main interview and initial BP recording, 4 of them were excluded because they could not complete the required BP readings period. We hipofension patients; Females were older One hundred and seventeen subjects Only one patient had a history of syncope, but Table 1 shows postprnadial main findings distributed by gender.
It was found that Table 2 shows the main results. There were neither important differences regarding medical history, age and gender distribution nor regarding symptoms prior to the study. Both systolic and diastolic BP values began to show differences from the hipotenion 20 on for breakfast and from minute 10 on for lunch.
Those differences became statistically significant from minute 30 and 20, respectively. The nadir of BP after breakfast was reached between minutes 50 and 60 Fig.
The same was observed after lunch. The BP posttprandial returned toward baseline levels after minute The only postprandiap that showed any difference was drowsiness. There were no significant differences concerning the medications used, even though patients in the PPH group used less Angiotensin Converting Enzyme Inhibitors ACEIdiuretics, nitrates and biguanides or sulfonylureas and used more beta-blockers and digoxin.
In this first “gross” comparison, the diet composition did not show any significant differences neither by grams nor by proportion of macronutrients carbohydrates, hipotensikn, and proteinsbut the total caloric intake, although non-significant, was slightly higher in the PPH group.
One-hundred eight subjects These patients were The meals’ nutrient composition was alike in both groups.
The Minimental and Minnesota scores did not show significant differences. This group included 66 patients The main physiologic changes concerned blood pressure readings Table 4.
Postprandial hypotension and parkinsonian state in Parkinson’s disease.
Patients with significant PPH had a higher prevalence of dementia and Parkinson’s disease. Most of the symptoms referred in the previous groups were concentrated in the “significant PPH” group, especially weakness and drowsiness after both breakfast and lunch. Patients with significant PPH showed worst quality of life measurements, but there were no significant differences regarding the medications used, neither in the food macronutrients composition. We found patients in a specific care facility and patients living in their family home.
Institutionalized patients were older The institutionalized people group showed more chronic diseases, being dementia the most significant 25 patients – Post-prandial hypotension was more frequent in the Institutionalized patients group in any of its variants one of two meals, or both surveyed postprxndial.
Even though, when comparing the prevalence of people with significant PPH, the difference between both groups was lost. Institutionalized patients had a higher total caloric intake in breakfast related to a higher carbohydrate and protein intake. During lunch, institutionalized patients had a higher carbohydrate intake and a lower protein intake than people at the family home.
Patients at family home use ACEI more frequently than institutionalized patients, which in turn, use more calcium channel blockers, aspirin, digoxin, benzodiazepines and vitamin supplements. The logistic regression analysis did not show any strong associations. The net prevalence of PPH in the elderly has not been extensively studied. This population is similar to the one studied by Aronow in the mid-nineties of the past century, with comparable results concerning PPH’s prevalence.
The first two analyses people with PPH after one or after the two studied meals did not show significant differences between groups with and without PPH, but the group with “significant PPH” did show some differences regarding the demographic characteristics and the medical history.
Those patients were older, had more dementia and a worst quality of life, although these two last issues can be related to the post-prandial hypotension itself. All the subjects with PPH had more symptoms after meals; specifically they showed more drowsiness and a general feeling of weakness after breakfast and lunch. This can be related to a higher fall and injuries risk in this group of patients. The explanation most surely lies in the differential blood flow induced by digestion reducing cerebral perfusion.
But with the food composition analysis, it is very difficult to relate PPH with a high carbohydrate intake. We have to note that the diet composition is very close to the usual suggestions of macronutrients distribution in the institutionalized setting that usually have a nutritionist’s participation, but also at the family homes that rely mainly on intuition to prepare food for the whole family. It has to be noted that the institutionalized patients live in an urban setting, and that the people studied in their family home lived mostly in a rural context.
There are small differences regarding the BP behavior when comparing breakfast with lunch.