Postprandial systolic blood pressure responses of older people in residential care: association with risk of falling.

BACKGROUND

The association between postprandial blood pressure, falls and medications is controversial.

OBJECTIVE

To investigate cardiovascular responses to meals in elderly people together with clinical associations and therapeutic issues.

METHODS

A cross-sectional observational study of 179 semi-independent older people (age 83.2 +/- 7.0 years) in residential care facilities was undertaken. Data on the frequency of falls, medical and medication history and measurement of blood pressure before and after a breakfast meal, and then after standing and walking after the meal were documented.

RESULTS

Postprandial hypotension (>/=20 mm Hg fall in systolic blood pressure (SBP)) and low absolute SBP (</=115 mm Hg) were common after meals and exacerbated by standing. Risk factors for low postprandial SBP included use of selective serotonin reuptake inhibitors (OR = 4.3, CI 1.4-13.1, p = 0.006), antipsychotic medications (OR = 5.2, CI 1.4-19.2, p = 0.007) and a history of smoking (OR = 4.7, CI 1.5-14.9, p = 0.005). Antihypertensive therapy ameliorated the postprandial decline in blood pressure. The incidence of falls was increased only in the 10% of subjects with low postprandial SBP.

CONCLUSIONS

Significant adverse cardiovascular change is common after meals in older people and a postprandial SBP of <115 mm Hg was associated with a history of falls. Selective serotonin reuptake inhibitors and antipsychotic medications were associated with low postprandial SBP, which may provide a mechanism for their association with falls. Hypertension was positively and antihypertensive therapy negatively associated with postprandial hypotension.