INTRAINDIVIDUAL REPRODUCIBILITY OF POSTPRANDIAL AND ORTHOSTATIC BLOOD-PRESSURE CHANGES IN OLDER NURSING-HOME PATIENTS - RELATIONSHIP WITH CHRONIC USE OF CARDIOVASCULAR MEDICATIONS

OBJECTIVES: Although postprandial and orthostatic hypotension are comm only observed in nursing home residents, their reproducibility, relati onship to each other, and association with chronic use of cardiovascul ar medications are poorly understood. DESIGN: We examined blood pressu re (BP) and heart rate (HR) before and after postural change, and befo re and after a 419-kcal meal in 22 nursing home residents (mean age 89 +/- 5 (SD) years), each on two occasions, to determine reproducibilit y of changes. These studies were repeated in 17 residents, with and wi thout previous administration of cardiovascular medications, in random order. SETTING: Hebrew Rehabilitation Center for the Aged, an academi c long-term care facility. RESULTS: Systolic BP declined an average (/- SE) of 16 +/- 4 mm Hg and 12 +/- 4 mm Hg during the first and secon d meal studies, respectively. Mean intra-class correlation of post pra ndial systolic BP values during the two studies was 0.88 (95% CI 0.85- 0.97). Systolic BP increased significantly during the first posture te st to a maximum of 8 +/- 6 mm Hg at 6 minutes. There was no significan t difference over time in postural systolic BP between the two tests. Repeated postural studies showed a mean intra-class correlation of 0.7 2 (95% CI 0.62-0.92) for changes in systolic BP. Cardiovascular medica tions had no additional effect on mean postprandial or orthostatic BP and HR changes. During the first studies, 10 subjects had postprandial hypotension, and three subjects had orthostatic hypotension, but only two of 22 subjects had both. CONCLUSIONS: Patterns of systolic BP res ponse to meals or postural change are reproducible. BP responses to me als and postural change seem to be unaffected by potentially hypotensi ve medications in chronic users. Postprandial hypotension is distinct from orthostatic hypotension, occurring more commonly than orthostatic hypotension and infrequently together in the same patients.