Postprandial hypotension in older people

Abstract

Postprandial hypotension refers to an excessive decline in blood pressure that occurs following a meal. This occurs commonly among older people and is clinically relevant as it is associated with multiple negative consequences, including falls, which itself has significant detrimental medical, psychological, functional and socio-economic consequences. As the ageing population is increasing, postprandial hypotension is going to be an increasingly prevalent condition. Where possible, it is important to prevent this, in order to maintain an older persons’ functional independence. Therefore appropriate management strategies are required to address postprandial hypotension. However, current management strategies are sub-optimal. Non-pharmacological strategies have not been specifically evaluated in older people and available options may not be widely applicable, whereas pharmacological strategies may result in potential adverse effects (a) The primary goal of the research reported in this thesis was to determine the effects of low-intensity, intermittent walking on postprandial blood pressure among older people with PPH. The hypothesis was that low-intensity, repeated exercise would attenuate the hypotensive effects of a glucose drink in older people with PPH, and that this effect would be sustained for the duration of the exercise. The results of the investigation provided evidence for the first time that intermittent walking exercise is an effective and practical therapeutic option for older people with PPH. (b) There is a gap in our knowledge about the ways in which gait parameters can be influenced by a decline in blood pressure after a meal, as observed in people with PPH. We therefore initiated a study designed to determine whether a postprandial decline in SBP following a 50 g glucose drink would affect gait parameters in older people with and without PPH. We hypothesised that the decline in blood pressure among older people with PPH would detrimentally affect gait parameters compared to the effect on older people without PPH. The results showed that postprandial BP decline does affect gait parameters, an insight which will assist in understanding the relationship between PPH, gait impairments and falls. (c) In addition, we sought to determine in older hospitalised patients the prevalence of NOF fractures occurring within two hours of a meal and the factors associated with these fractures, since this is the time when postprandial hypotension occurs. Results indicated that one-fifth of fractures occurred within two hours of a meal. Patients who sustained a NOF fracture within two hours of a meal were more likely to be from residential care, experience symptoms associated with hypotension before a fall and have a history of recurrent falls in the preceding 12 months than patients who fell after more than two hours following a meal.