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Meal-induced blood pressure variation and cardiovascular mortality in ambulatory hypertensive elderly patients: preliminary results

Zanasi, Andrea; Tincani, Enrico; Evandri, Valeria; Giovanardi, Paolo; Bertolotti, Marco; Rioli, Giuseppe

doi: 10.1097/HJH.0b013e328357f16d

Objectives: This prospective cohort study was designed to investigate the prevalence and the prognostic value of postprandial hypotension (PPH) in ambulatory hypertensive elderly patients without overt heart diseases, an issue that has never been evaluated so far.

Methods: All patients consecutively referred to our cardiologic clinic in the period from January 2005 to August 2009, were enrolled in the study and underwent a 24-h ambulatory arterial blood pressure monitoring (ABPM). PPH has been defined as a decrease in SBP of 20 mmHg within 2 h after a meal.

Results: Four hundred and one patients were enrolled (mean age 77.7 ± 11 years, males 47.7%). Hypertension was not adequately controlled in 290 (72.3%) patients. PPH was found in 292 of 401 (72.8%) patients. A value of 10 mmHg or higher of SD SBP was predictive of PPH, with a sensitivity and specificity of 87 and 57%, respectively. At each meal, patients with higher SBP readings before meal had the greatest decrease in SBP (P < 0.001). During the follow-up, 34 patients died for cardiovascular causes. Breakfast BP variation was the most predictive variable of cardiovascular mortality (B = 0.020, P = 0.04, HR 1.020, IC 1.001–1.040).

Conclusion: In our population, PPH was common. A diurnal standard deviation of SBP of 10 mmHg or higher was suggestive of its presence. ABPM identified breakfast BP decrease as a possible new risk factor for cardiovascular mortality.

aDivision of Geriatric Medicine, University of Modena and Reggio Emilia

bUnità Operativa di Post Acuzie e Lungodegenza

cUnità Operativa di Medicina Cardiovascolare, Nuovo Ospedale Civile S. Agostino-Estense, Modena, Italy

Correspondence to Dr Andrea Zanasi, Nuovo Ospedale Civile S. Agostino-Estense, Modena, Via Giardini 1355, 41126 Modena, Italy. Tel: +39 0536846521; fax: +39 0536846574; e-mail:

Abbreviations: AASI, ambulatory arterial stiffness index; ABPM, ambulatory blood pressure monitoring; ACEi, angiotensin II converting enzyme inhibitors; ARB, angiotensin II receptor blocker; BPV, BP variation; CI, confidence interval; HR, hazard ratio; MBPS, morning BP surge; NYHA, New York Heart Association; PPH, postprandial hypotension

Received 26 March, 2012

Revised 30 June, 2012

Accepted 10 July, 2012

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.