Association of postprandial hypotension with incidence of falls, syncope, coronary events, stroke, and total mortality at 29-month follow-up in 499 older nursing home residents.

OBJECTIVE

To investigate whether a marked decrease in postprandial systolic blood pressure correlates with a higher incidence of falls, syncope, new coronary events, new stroke, and total mortality at long-term follow-up in older nursing home residents.

DESIGN

In a prospective study of 499 nursing home residents aged 62 years or older, at 29-month mean follow-up, the maximal reduction in postprandial systolic blood pressure was correlated with the incidence of falls, syncope, new coronary events, new stroke, and total mortality.

SETTING

A large long-term health care facility.

PATIENTS

The 499 ambulatory or wheelchair-bound residents included 354 women and 145 men, mean age 80 +/- 9 years (range 62-100).

MEASUREMENTS AND MAIN RESULTS

The mean follow-up was 29 +/- 10 months (range 1-36). At follow-up, falls had occurred in 199 persons (40%), syncope in 72 persons (14%), new coronary events in 139 persons (28%), new stroke in 61 persons (12%), and total mortality in 199 persons (40%). The mean maximal decrease in postprandial systolic blood pressure was 20 +/- 5 mm Hg for persons with falls and 12 +/- 4 mm Hg in persons without falls (P < 0.001); 23 +/- 5 mm Hg in persons with syncope and 14 +/- 5 mm Hg in persons without syncope (P < 0.001); 18 +/- 6 mm Hg in persons with coronary events and 14 +/- 5 mm Hg in persons without coronary events (P < 0.001); 21 +/- 6 mm Hg in persons with stroke and 15 +/- 5 mm Hg in persons without stroke (P < 0.001); and 17 +/- 6 mm Hg in persons who died and 15 +/- 5 mm Hg in persons who did not die (P < 0.001). Maximal decrease in postprandial systolic blood pressure was an independent risk factor for falls, syncope, new coronary events, new stroke, and total mortality. Age was an independent risk factor for new coronary events and for total mortality. Male sex was an independent risk factor for syncope, new coronary events, stroke, and total mortality. Prior falls was an independent risk factor for new falls. Prior syncope was an independent risk factor for new syncope. Prior stroke was an independent risk factor for new stroke.

CONCLUSIONS

A marked reduction in postprandial systolic blood pressure in older nursing home residents was associated at long-term follow-up with a higher incidence of falls, syncope, new coronary events, new stroke, and total mortality.