Upright posture and postprandial hypotension in elderly persons

Background: Syncope and falls are common in elderly persons and often resul t 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 hypoten sion 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]). Twent y-five participants (50%) were taking antihypertensive medication. Measurements: sequential head-up tilt-table testing at 60 degrees was perfo rmed before and 30 minutes after ingestion of a standardized warm liquid me al that was high in carbohydrates. Heart rate and blood pressure were conti nuously monitored. Results: Meal ingestion (P < 0.01) and time spent upright (P < 0.001) were significantly associated with systolic blood pressure, but no significant i nteraction was found between meal ingestion and time spent upright (P > 0.2 ). These findings suggest that the association between meal ingestion and h ead-up tilt-table testing were additive and not synergistic. However, the p roportion of participants with symptomatic hypotension increased during hea d-up tilt-table testing after meal ingestion (12% during preprandial testin g and 22% during postprandial testing). Symptomatic hypotension tended to o ccur 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 w ith increasing occurrences of symptomatic hypotension. After meal ingestion and head-up tilt-table testing, 22% of functionally independent elderly pe rsons had symptomatic hypotension.