Abbas R, Tanguy A, Bonnet-Zamponi D, Djedid R, Lounis A, Gaubert-Dahan M-L
Rachid Abbas, Département d'épidémiologie et recherche clinique, CIC-EC 1425, AP-HP, Hôpital Bichat, Paris France,
J Frailty Aging. 2018;7(1):28-33. doi: 10.14283/jfa.2018.2.
Postprandial hypotension (PPH) is an important disorder in the older people that remain underdiagnosed. The reference PPH diagnostic method is too demanding, because blood pressure (BP) needs to be measured 8 times in 2 hours.
Our primary objective was to define a new simplified PPH diagnostic method and to evaluate its performances.
We conducted a cross-sectional study.
Two geriatric rehabilitation units in France.
104 patients (70 women, 34 men) with high risk of PPH were included.
BP was measured twice before the midday meal in seated position at the table, and every 15 minutes for 90 minutes after the end of the meal. Receiver Operating Characteristic curves were plotted for each postprandial BP measure to determine the best postprandial measure in terms of sensitivity and specificity. The optimal diagnostic threshold was calculated with Youden's index according to BP difference before and after the meal.
A new simplified diagnostic method is proposed: a decrease of at least 10 mmHg systolic BP between BP measures before the meal and 75 minutes after the end of the meal. This new method had a sensitivity of 82% (95%CI 66 - 92) and a specificity of 91% (95%CI 81 - 97).
This new diagnostic method is fast, efficient and suitable for everyday use. It could improve PPH diagnosis in older people. Larger studies are needed to validate it.
餐后低血压（PPH）是老年人中一种重要但仍未得到充分诊断的疾病。参考的PPH诊断方法要求过高，因为需要在2小时内测量8次血压（BP）。
我们的主要目的是定义一种新的简化PPH诊断方法并评估其性能。
我们进行了一项横断面研究。
法国的两个老年康复单元。
纳入了104例PPH高风险患者（70名女性，34名男性）。
在午餐前坐在餐桌旁时测量两次血压，餐后结束后每15分钟测量一次，共测量90分钟。绘制每个餐后血压测量值的受试者工作特征曲线，以确定在敏感性和特异性方面最佳的餐后测量值。根据餐后前后血压差值，用约登指数计算最佳诊断阈值。
提出了一种新的简化诊断方法：餐后75分钟时收缩压较餐前测量值至少降低10 mmHg。这种新方法的敏感性为82%（95%CI 66 - 92），特异性为91%（95%CI 81 - 97）。
这种新的诊断方法快速、有效且适用于日常使用。它可以改善老年人PPH的诊断。需要更大规模的研究来验证它。
