| Objective:To investigate the effect of lie-down position and semi-supine position on postprandial blood pressure of elderly patients with essential hypertension with postprandial hypotension(PPH)within 2 hours after meal,and to find the posture that reduce the incidence of PPH.Methods:This is a randomized controlled study design.A total of 96 elderly patients with essential hypertension and PPH were recruited from the cardiac ward of China-Japan Friendship Hospital from January to December,2019.The patients were randomly assigned to the.lie-down group,the semi-supine group and the control group by block random method.The time started from the first bite of the patient's breakfast,and the total time was 120min(the patients were required to finish the meal within 30min,followed by postural intervention).Patients in the lie-down group were required to lie down after meals;Patients in the semi-supine group adopted a 45° semi-recumbent position after meals;Patients in the control group performed daily activities after meals,but they were not allowed to lie down or take a semi-supine position for more than 30 minutes.Blood pressure was measured at 15min before meal,the beginning of meal,30min,60min,90min and 120min.And the changes in blood pressure,PPH incidence,blood pressure variability,heart rate,PPH symptoms,and satisfaction score were compared among the three groups.Frequency,percentage,mean and standard deviation were used to describe the general data of patients.The difference of postprandial systolic blood pressure(SBP)?postprandial diastolic blood pressure(DBP)?heart rate among the three groups were compared by the analysis method of repeated measurement data.The postprandial blood pressure change trend and the heart rate trend of the three groups were plotted.Chi-square test,nonparametric test,AN OVA and LSD were used to compare the PPH incidence,blood pressure variability,PPH symptom score and satisfaction score of the three groups.Results:Among the 96 participants included,4 were exfoliated and 92 were eventually treated,including 31 in the lie-down group,31 in the semi-supine group and 30 in the control group.1.postprandial blood pressure in the three groups:(1)There was no significant difference in SBP and DBP among the three groups after meals(P>0.05).Both SBP and DBP changed with time after meals(P<0.05).There was no interaction between postural and temporal factors(P>0.05).(2)Comparing the difference value of postprandial blood pressure in different periods among groups,there was no statistical difference in each period among the three groups(P>0.05).(3)The difference value of postprandial blood pressure in different time periods was compared within the three groups,and there were statistical differences within all three groups(P<0.05).Multiple LSD comparison results of SBP in each group:?the change trend of the lie-down group was consistent with that of the control group,and the SBP decline trend was observed within 0?30min,with a decrease of more than 10 mmHg and a large fluctuation range compared with other periods in both groups(P<0.05),and the fluctuation amplitude difference between other periods was not obvious(P>0.05);?SBP in the semi-supine position group decreased significantly within 0?30min,and showed an upward trend within 90?120min,with a large fluctuation range compared with other periods in the group(P<0.05),and the difference was statistically significant(P<0.05).Multiple LSD comparison results of DBP in each group:DBP of the lie-down group,semi-supine position group and the control group decreased within 30 minutes after meal,and the difference among the three groups was statistically significant(P<0.05).(4)Results of repeated measurements of postprandial blood pressure stratified by age in three groups:There was no statistically significant difference between SBP and DBP 2 hours after meals in the three groups(P>0.05);Postprandial SBP changed over time in all three groups of younger elderly and older elderly patients(P<0.05);Postprandial DBP changed with time in younger elderly and older elderly patients(P<0.05),while DBP changed in older elderly patients are not related to time development(P>0.05);There was no interaction between postural and temporal factors(P>0.05).2.The incidence of PPH in the lie-down group,semi-supine group and control group were 80.65%,80.65%,86.67%,respectively.There was no statistical difference in the incidence of PPH among the three groups(P>0.05).3.There was no statistical difference in SBP variability and DBP variability among the three groups(P>0.05).4.Results of repeated measurements of heart rate before and after meals in three groups:There was no statistically significant difference among the three groups in the change of heart rate at 2 hours after meals(P>0.05).The postprandial heart rate of all the three groups changed with time(P<0.05);There was no interaction between postural and temporal factors(P>0.05).5.There was no statistical difference in symptom scores among the three groups(P>0.05).A total of 11 patients developed PPH symptoms,including 1 in the lie-down group,5 in the semi-supine group and 5 in the control group.There was no statistical difference between the three groups(P>0.05).Dizziness was the most common PPH symptom,followed by headache,vertigo,fatigue and chest pain6.There was a statistical difference in the total satisfaction scores?item 1 "I feel comfortable in this position/state after breakfast" and item 2 "I don't feel tired after breakfast in this position/state" of the three groups(P<0.05).LSD multiple comparison results:the total scores of satisfaction and item 2 of the semi-supine group were lower than those of the other two groups(P<0.05);The score of item 1 of semi-supine group was lower than that of the lie-down group(P<0.05).There was no difference in item 3 "I can hold this position/state for 2 hours after breakfast" among the three groups(P>0.05);the score of item 4 "generally speaking,I am satisfied with this position/state" of the semi-supine group was lower than that of the control group(P<0.05).Conclusions:1.Lying down or keep semi-supine after meals has no obvious effect on the change of postprandial blood pressure after meals in elderly adults with essential hypertension with PPH.There is no difference in the influence of body position on the postprandial blood pressure of younger elderly patients and older elderly patients.The changes of postprandial blood pressure in patients with different postprandial positions are basically the same:the patient's blood pressure decrease significantly within 30 minutes after meal,and then fluctuate steadily at a relatively low level.It is suggested that for elderly patients with essential hypertension and PPH,no matter what position they take after meals,blood pressure should be paid close attention within 30 minutes after meal.2.Lying down or keep semi-supine after meals can neither reduce the incidence of PPH nor reduce the variability of postprandial blood pressure of elderly patients with essential hypertension with PPH.3.Lying down position or keep semi-supine position after meals has no effect on heart rate of elderly patients with essential hypertension with PPH.4.Most elderly patients with essential hypertension with PPH have no symptoms of PPH,and the presence or absence of symptoms has nothing to do with body position.Dizziness is the most common symptom of PPH in elderly patients with essential hypertension.5.Elderly patients with essential hypertension with PPH who take a semi-supine position after meals often feel significantly uncomfortable and tired. |
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