Upright Posture and Postprandial Hypotension in Elderly Persons

  1. Mathew S. Maurer, MD;
  2. Wahida Karmally, MS, RD, CDE;
  3. Harold Rivadeneira, BS;
  4. Michael K. Parides, PhD; and
  5. Daniel M. Bloomfield, MD
  1. From Columbia University, New York, New York.

    Abstract

    Background: Syncope and falls are common in elderly persons and often result from the interaction of multiple clinical abnormalities. Both orthostatic hypotension and postprandial hypotension increase in prevalence with age.

    Objective: To determine whether meal ingestion enhances orthostatic hypotension in elderly persons.

    Design: Controlled paired comparison.

    Setting: Clinical research center.

    Patients: 50 functionally independent elderly persons recruited from local senior centers (n = 47) and from patients hospitalized with an unexplained fall or syncope (n = 3) (mean age, 78 years [range, 61 to 96 years]). Twenty-five participants (50%) were taking antihypertensive medication.

    Measurements: Sequential head-up tilt-table testing at 60 degrees was performed before and 30 minutes after ingestion of a standardized warm liquid meal that was high in carbohydrates. Heart rate and blood pressure were continuously monitored.

    Results: Meal ingestion (P < 0.01) and time spent upright (P < 0.001) were significantly associated with systolic blood pressure, but no significant interaction was found between meal ingestion and time spent upright (P > 0.2). These findings suggest that the association between meal ingestion and head-up tilt-table testing were additive and not synergistic. However, the proportion of participants with symptomatic hypotension increased during head-up tilt-table testing after meal ingestion (12% during preprandial testing and 22% during postprandial testing). Symptomatic hypotension tended to occur more often and sooner after meal ingestion than before meal ingestion (P = 0.03).

    Conclusions: Meal ingestion and head-up tilt-table testing are associated with increasing occurrences of symptomatic hypotension. After meal ingestion and head-up tilt-table testing, 22% of functionally independent elderly persons had symptomatic hypotension.

    Article and Author Information

    • Grant Support: In part by grant HL-03466 from the National Institutes of Health. The study was conducted in the Irving Center for Clinical Research, supported by M01 RR-00645, Division of Research Resources, General Clinical Research Centers Program, National Institutes of Health, Bethesda, Maryland. Dr. Maurer was the recipient of the Merck Adult Cardiology fellowship of the American College of Cardiology.

    • Requests for Single Reprints: Mathew S. Maurer, MD, Division of Circulatory Physiology, College of Physicians and Surgeons, Columbia University, 177 Fort Washington Avenue, MHB5-435, New York, NY 10032; e-mail, msm10{at}columbia.edu.

    • Current Author Addresses: Dr. Maurer: Division of Circulatory Physiology, College of Physicians and Surgeons, Columbia University, 177 Fort Washington Avenue, MHB 5-435, New York, NY 10032.

    • Dr. Karmally: The Irving Center for Clinical Research, Columbia University, 630 West 168th Street, New York, NY 10032.

    • Mr. Rivadeneira: Memberworks, Inc., 9 West Broad Street, Stamford, CT 06492.

    • Dr. Parides: Division of Biostatistics, PH18-310, Joseph L. Mailman School of Public Health, Columbia University, 630 West 168th Street, New York, NY 10032.

    • Dr. Bloomfield: Division of Cardiology, PH 3-342, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032.

    • Author Contributions: Conception and design: M.S. Maurer, D.M. Bloomfield.

    • Analysis and interpretation of the data: M.S. Maurer, H. Rivadeneira, M.K. Parides, D.M. Bloomfield.

    • Drafting of the article: M.S. Maurer.

    • Critical revision of the article for important intellectual content: M.K. Parides, D.M. Bloomfield.

    • Final approval of the article: M.S. Maurer, W. Karmally, H. Rivadeneira, M.K. Parides, D.M. Bloomfield.

    • Provision of study materials or patients: M.S. Maurer, W. Karmally, H. Rivadeneira.

    • Statistical expertise: M.K. Parides.

    • Obtaining of funding: M.S. Maurer.

    • Administrative, technical, or logistic support: W. Karmally, H. Rivadeneira, D.M. Bloomfield.

    • Collection and assembly of data: M.S. Maurer, H. Rivadeneira.

    Summary for Patients

    • Summaries for Patients:Blood Pressure in Older Adults after Meals and Standing Up Ann Intern Med October 3, 2000 133:I-48
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    1. Ann Intern Med October 3, 2000 vol. 133 no. 7 533-536
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