Ambulatory blood pressure monitoring and postprandial hypotension in elderly persons with falls or syncopes

Background. Postprandial hypotension (PPH) is increasingly recognized as a common cause of falls and syncope in elderly persons. Noninvasive ambulator y blood pressure monitoring (ABPM) has been recommended for detecting PPH. This study investigates postprandial blood pressure (BP) changes by means o f ABPM in elderly patients experiencing falls or syncopes. Methods. Twenty-four-hour ABPM was performed in 156 inpatients (111 women, mean age 80.1 +/- 8.1 years). Among them, 45 had been admitted for falls an d 75 for syncope; 36 with no history of falls or syncope served as controls . Postprandial change in systolic blood pressure (Delta SBP) was calculated by subtracting the mean SEP within the 2 hours following the meal from the mean SEP within the 2 hours preceding the meal. PPH was defined by a Delta SBP greater than or equal to 20 mm Hg. Results. For the entire group, mean SEP decreased after the three meals. On average, the decline in SEP was greater after breakfast than after lunch o r dinner, and the number of patients experiencing PPH was greater after bre akfast. Average maximal Delta SBP was significantly larger in the syncope g roup than in the other groups (p < .05). Moreover, the number of patients e xperiencing PPH was significantly higher in the syncope/fall group than in the control group (23% vs 9; p = .03). Compared with patients without PPH, patients with PPH were more likely to have a history of diabetes mellitus ( p < .01) or to use more than three different drugs daily (p =.04), and they showed greater daytime SEP variability (p < .0001). Furthermore, there was a strong positive correlation between preprandial SEP and <Delta>SBP after breakfast. Conclusions. About one out of four elderly patients with falls or syncope e xperiences PPH, usually after breakfast. Postprandial decline in BP contrib utes to BP variability. Delta SBP and preprandial SEP are positively correl ated.