The Prevalence And Risk Factors Of Postprandial Hypotension In Patients With Coronary Heart Disease

Objective: The main feature of postprandial hypotension is the blood pressure being lower compared with that before a meal, and it may lead to syncope, fall, dizziness, nausea, visual disturbance, cardiovascular events, brain stroke and even death when it has a sharply fall. The prevalence of postprandial hypotension varies in different people, such as the prevalence of the aged in nursing home is 33%, and the elderly or some patients of malignancies can reach 72.8%. As the research proceeds in recent years, the postprandial hypotension is regarded as an important clinical problem. This study focuses on patients with coronary heart disease to explore the prevalence of postprandial hypotension among patients with coronary heart disease and relevant risk factors.Method: Choose 289 patients with coronary heart disease, who have been treated in the first department of cardiology of our hospital from December, 2013 to December, 2014. Age range: 24-90, average age: 62.00±12.22. All patients are divided into four groups on the basis of age: age under 60:124 patients in the group, and the average age is 50.49±7.08, male patients 88 along with female patients 36; age 60-69: 84 patients in the group, and the average age is 64.81±2.80, male patients 52 along with female patients 32; age 70-79: 59 patients in the group, and the average age is 74.39±2.39, male patients 31 along with female patients 28; age 80-90: 22 patients in the group, and the average age is 82.91±2.54, male patients 10 along with female patients 12.The blood pressure of patients need to be measured with electronic sphygmomanometer before breakfast, lunch and dinner as well as 30, 60,90 and 120 min after meal, and the patients should in horizontal position during blood pressure measurement along with cuff on the left arm for measuring left brachial artery blood pressure. The falling range of blood pressure after meals is defined as: systolic blood pressure before meals and systolic blood pressure after meals. Systolic blood pressure after meals is the lowest systolic blood pressure value within 120 minutes after meals. Postprandial hypotension is defined as the falling range of blood pressure after meals≥20mm Hg.The average blood pressure before breakfast, lunch and dinner is deemed as basic blood pressure. The gender and age of patients, body position during meals, and whether they have hypertension, hyperlipemia, diabetes, cerebrovascular disease or take medications which affect blood pressure(includes CCB, ARB, ACEI antihypertensive and diuretics) need to be recorded,and adverse events should also be recorded. The SPSS 19.0 software package is used for statistical processing. The quantitative data is expressed by using mean ± standard deviation, t test for comparison between two groups and single factor variance analysis for comparison among groups; the qualitative data is expressed by percentage, χ2 test for comparison between two groups; the logistic regression is used for analyzing related risk factors of postprandial hypotension. P<0.05 has statistical significance.Results:1 The systolic blood pressure of a total of 50 cases of 289 patients drops ≥20mm Hg, and the prevalence of postprandial hypotension is 17.30%.there are 28 males(9.69%) and 22(7.61%)females and the prevalence difference of postprandial hypotension has no statistical significance(P>0.05).Among patients with diabetes, 9 patients have postprandial hypotension along with prevalence 3.11%; among patients with cerebrovascular disease, 9 patients have postprandial hypotension along with prevalence 3.11%; among patients with hypertension, 44 patients have postprandial hypotension along with prevalence 15.22%; among patients with hyperlipemia, 20 patients have postprandial hypotension along with prevalence 6.92%;the difference of postprandial hypotension among patients with other diseases has no statistical significance(P>0.05).Among patients with taking medications which affect the blood pressure, 45 patients have postprandial hypotension along with prevalence 15.57%; 5 patients without taking medications which affect the blood pressure have postprandial hypotension along with incidence 1.73%;the difference of postprandial hypotension has statistical significance(P<0.05). The prevalence of postprandial hypotension for different age groups shows as follows: age under 60 group:22 patients(7.61%);age 60-69 group:12 patients(4.15%);age 70-79 group:10 patients(3.46%);age 80-90 group:6 patients(2.08%),the prevalence difference of different age groups has no statistical significance(P>0.05).The prevalence of postprandial hypotension of breakfast, lunch and dinner is 8.10%, 5.19% and 9.00% according the analysis of different mealtime, and the prevalence difference of different mealtime has no statistical significance(P>0.05).Divide all patients into groups by basic systolic blood pressure level, basic systolic blood pressure under 120 mm Hg: 59 patients in the group, 6 of them have PPH, with prevalence of 2.08%; basic systolic blood pressure between 120-129 mm Hg:89 patients in the group, 8 of them have PPH, with prevalence of 2.77%; basic systolic blood pressure between 130-139 mm Hg:86 patients in the group, 12 of them have PPH, with prevalence of 4.15%;basic systolic blood pressure 140 mm Hg and higher:55 patients in the group, 24 of them have PPH, with prevalence of 8.30%.2 The clinc feature、the combination of disease、medicine condition、posture condition has no statistical significance.3 Taking medications which affect the blood pressure and basic blood pressure level are risk factors for postprandial hypotension and corresponding OR is 4.05(95%CI 1.52-10.79) and 1.84(95%CI 1.37-2.49).4 12 patients had adverse events during the period in hospital.5 of them are with PPH,adverse events respectively are:1 with new-onset AMI, 4 cerebral infarction.7 of them are without PPH, adverse events are all cerebral infarction. The occurrence of adverse events between difference group has no statistical significance(P>0.05)Conclusion: The prevalence of postprandial hypotension for patients with coronary heart disease is 17.30%. There is no oblivious relevance between postprandial hypotension and gender, age, body position during meal and whether patients have high blood pressure, hyperlipemia, diabetes and cerebral vascular disease. Taking medications which affect the blood pressure and basic blood pressure level are risk factors for postprandial hypotension. PPH has no significant influence in occurrence of adverse events among patients with coronary heart disease. Therefore, it is necessary to enhance blood pressure monitoring in patients with coronary heart disease while make record of medicine which affect the blood pressure that patients take,so that we can recognize postprandial hypotension in time and give intervention.