Teramoto S, Akishita M, Fukuchi Y, Toba K, Ouchi Y
Department of Geriatrics, Faculty of Medicine, University of Tokyo, Japan.
Hypertens Res. 1997 Dec;20(4):257-61. doi: 10.1291/hypres.20.257.
To examine the role of autonomic nervous dysfunction in postprandial hypotension (PPH) in elderly persons, we non-invasively assessed autonomic nervous function in 50 elderly subjects with or without PPH, defined as a reduction of more than 20 mmHg in systolic blood pressure (SBP) after a meal. The heart rate response to the reduction of SBP during head-up tilt was less and the coefficient of variation of R-R intervals was smaller in subjects with PPH than in those without PPH. The responses to cold pressor test, hyperventilation test, and mental arithmetic test were normal in all subjects. The magnitude of deltaSBP after meal ingestion closely correlated with deltaSBP during tilt-table examination, but did not correlate with the results of the cold pressor test, hyperventilation test, or mental arithmetic test. Stepwise multiple regression analysis revealed that the magnitude of the BP reduction and heart rate increase during the tilt-table test were independent predictors of the magnitude of deltaSBP after meal ingestion. The results indicate that impaired afferent pathways of baroreflexes, including baroreceptors, may play an important role in the pathogenesis of postprandial hypotension in the elderly and that the magnitude of the fall in SBP during tilt-table testing may be related to the degree of the postprandial reduction in BP in elderly persons.
为研究自主神经功能障碍在老年人餐后低血压（PPH）中的作用，我们对50名有或无PPH的老年受试者进行了自主神经功能的无创评估，PPH定义为餐后收缩压（SBP）下降超过20 mmHg。与无PPH的受试者相比，PPH受试者在头高位倾斜期间对SBP降低的心率反应较小，R-R间期的变异系数也较小。所有受试者对冷加压试验、过度通气试验和心算试验的反应均正常。餐后摄入后SBP的变化幅度与倾斜台检查期间的SBP变化幅度密切相关，但与冷加压试验、过度通气试验或心算试验的结果无关。逐步多元回归分析显示，倾斜台试验期间血压降低的幅度和心率增加是餐后摄入后SBP变化幅度的独立预测因素。结果表明，包括压力感受器在内的压力反射传入通路受损可能在老年人餐后低血压的发病机制中起重要作用，并且倾斜台试验期间SBP下降的幅度可能与老年人餐后血压下降的程度有关。
