Maurer M S, Karmally W, Rivadeneira H, Parides M K, Bloomfield D M
Division of Circulatory Physiology, College of Physicians and Surgeons, Columbia University, 177 Fort Washington Avenue, MHB 5-435, New York, NY 10032, USA.
Ann Intern Med. 2000 Oct 3;133(7):533-6. doi: 10.7326/0003-4819-133-7-200010030-00012.
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.
To determine whether meal ingestion enhances orthostatic hypotension in elderly persons.
Controlled paired comparison.
Clinical research center.
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.
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.
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).
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.
晕厥和跌倒在老年人中很常见，通常是多种临床异常相互作用的结果。直立性低血压和餐后低血压的患病率均随年龄增长而增加。
确定进食是否会加重老年人的直立性低血压。
对照配对比较。
临床研究中心。
从当地老年中心招募的50名功能独立的老年人（n = 47）以及因不明原因跌倒或晕厥住院的患者（n = 3）（平均年龄78岁[范围61至96岁]）。25名参与者（50%）正在服用抗高血压药物。
在摄入富含碳水化合物的标准化温热流食前和摄入后30分钟进行60度的连续头高位倾斜试验。持续监测心率和血压。
进食（P < 0.01）和直立时间（P < 0.001）与收缩压显著相关，但未发现进食与直立时间之间存在显著交互作用（P > 0.2）。这些发现表明，进食与头高位倾斜试验之间的关联是相加的而非协同的。然而，进食后头高位倾斜试验期间出现症状性低血压的参与者比例增加（餐前试验期间为12%，餐后试验期间为22%）。症状性低血压在进食后比进食前更常且更早出现（P = 0.03）。
进食和头高位倾斜试验与症状性低血压的发生率增加有关。进食和头高位倾斜试验后，22%的功能独立老年人出现症状性低血压。
