Postprandial Hypotension Features And Its Risk Factors In Elderly Patients With Hypertension

Objective:The purposes of this study were to observe the clinical characteristics and analysis its risk factors of postprandial hypotension(PPH) in elderly patients with essential hypertension through ambulatory blood pressure monitoring.Maybe it can provide the basis for clinical diagnosis and treatment of patients with PPH.Method:45 males and 33 females at the age of 60 to 90 years old were included in this study, the average age was(79.2±9.6). And based on age, they were further divided into two groups: 36 cases in group A(very old) from 80 to 90 years old,including 21 males and 15 females, the average age was(84.2±3.2). 42 cases in group B(old) from 60 to 79 years old, including 24 males and 18 females,the average age was(68.3±5.2). According to the occurrence of PPH is divided into two groups: 46 cases in group PPH from 65 to 90 years old, including 26 males and 20 females, the average age was(79.2 + 7.3). 32 cases in group NPPH from 60 to 83 years old, including 19 male and 13 female, the average age was(70.3 + 6.6). The blood pressure after meals of those patients wasV assessed per 30 min by ambulatory blood pressure monitoring. All of them took hypotensive drugs and hypoglycemic agents as usual. Fasting plasma glucose,norepinephrine and blood creatinine levels were measured by the automatic biochemical analyzer, then glomerular filtration rate(GFR) was calculated. In the meantime, Intima-media thickness(IMT) was respectively measured by high-resolution color Doppler scans ultrasonics, and recorded the average of three times measurement. Left ventricular posterior wall thickness(LVPWT),left ventricular end-diastolic diameter(LVDd), and interventricular septal thickness(IVST) were measured by echocardiogram in all the patients. left ventricular mass index(LVMI) was calculated. According to the ambulatory blood pressure monitoring, divided into whether has the postprandial hypotension, compared the occurrences of postprandial hypotension among varied ages, genders and meal time. the risk factors Logistic regression analysis, such as age, gender, body mass index(BMI),diabetes mellitus, left ventricular hypertrophy, carotid atherosclerosis,cerebrovascular disease and coronary heart disease. All the patients were diagnosed with essential hypertension in geriatrics department of China-Japan union hospital of Jilin University from Jan 2014 to Dec 2015.Results:1.The incidence of PPH in elderly patients with essential hypertension is58.97%; different gender was no statistical difference(P>0.05).2.The incidence of PPH in the very old group was higher than that in theVI old group(P<0.05).3.The prevalence of PPH at breakfast was the highest(48.72%), much higher than the lunch(33.33%) and dinner(35.90%)(P<0.05); However, there is no significantly difference between lunch and dinner(P>0.05). Futhermore,dramatically difference was found at each meal between very old group and old group(P<0.05 or P<0.01).4.The age in the patients with PPH was older(P<0.01) and BMI was lower(P<0.01) compared with the patients without PPH. What’s more, the rate associated with diabetes, cardiovascular and cerebrovascular diseases in the former one was remarkly higher than the latter one(P<0.05).5.The norepinephrine levels and glomerular filtration rate in the patients with PPH was lower than the patients without PPH(P<0.05); but there was no statistically significant difference between two groups for the recipient serum creatinine levels(P<0.05).6.Compared with non-PPH group, PPH group has higher incidence of carotid atherosclerosis(P<0.05); While, no statistically significant about the incidence of left ventricular hypertrophy and its indicators such as posterior wall thickness of left ventricular, left ventricular and diastolic dimension,interventricular septal thickness, left ventricular mass index among different groups(P > 0.05).7.Logistic regression analysis indicated that age, diabetes, cerebrovascular accident, and coronary heart disease are risk factors for the elderly patients withPPH, Body mass index is a protective factor for the occurrence of PPH.Conclusions:1.The incidence of PPH in elderly patients with essential hypertension is58.97%,which was no statistical significance between male and female(P>0.05).2.The older the elderly patient with essential hypertension was, the higher incidence of PPH at each meal and drop amplitude of blood pressure were. And that mainly occurred after breakfast(48.72%).3.Age, diabetes, cerebrovascular accident, and coronary heart disease are risk factors for the elderly patients with PPH, increase of BMI is conducive to prevention of PPH.4.Renal function and norepinephrine levels decline may take the responsibility for PPH.5.It is necessary to enhance the management of blood pressure in elderly patients with essential hypertension, pay attention to the level of blood pressure after meals, especially breakfast. so that we can recognize postprandial hypotension in time and give intervention to reduce the adverse consequences of postprandial hypotension.