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

Zanasi, Andrea; Tincani, E; Evandri, Valeria; Giovanardi, Paolo; Bertolotti, Marco; Rioli, G.

doi:10.1097/hjh.0b013e328357f16d

Cited by 25 publications

(22 citation statements)

References 27 publications

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“…Postprandial hypotension has also been noted to be a risk factor for CV mortality in the general population 15. In the present study, predialysis hypotension was not a predictor of all-cause mortality.…”

Section: Discussionsupporting

confidence: 41%

Predialysis hypotension is not a predictor for mortality in long-term hemodialysis patients: insight from a single-center observational study

Huang

Hsu

et al. 2016

TCRM

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IntroductionPredialysis hypotension has been noted to be a predictor of mortality in hemodialysis (HD) patients. Previous studies evaluating the impact of predialysis hypotension on the mortality of HD patients did not exclude patients with diabetes mellitus (DM) or cardiovascular disease.MethodsEight hundred and sixty-six patients on maintenance HD were recruited. Clinical parameters were recorded and subjected to the analysis of predictors of predialysis hypotension and mortality.ResultsMultivariate logistic regression analyses indicated that DM (odds ratio [OR]: 0.439, P=0.002), hypertension history (OR: 0.634, P=0.022), Kt/V Daugirdas (OR: 2.545, P=0.001), anuria (OR: 2.313, P=0.002), serum phosphate (OR: 0.833, P=0.010), and serum triglyceride (OR: 1.002, P=0.012) were associated with predialysis hypotension. Multivariate Cox regression analysis showed that age (P<0.001), male sex (P=0.029), anuria (P=0.004), and DM (P=0.011) were associated with higher probability of 24- and 36-month mortality. Predialysis hypotension was not associated with higher probability of 12-, 24-, and 36-month mortality.ConclusionPredialysis hypotension is not a predictor of 12-, 24-, and 36-month survival in patients without DM and with higher dialysis adequacy.

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Section: Discussionsupporting

confidence: 41%

Predialysis hypotension is not a predictor for mortality in long-term hemodialysis patients: insight from a single-center observational study

Huang

Hsu

et al. 2016

TCRM

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“…The main strengths of our work are the relatively large cohort of elderly patients, the simultaneous BP measurements, which is certainly the most accurate method to diagnose IAD, and the performance of IAD measurement on consequent days enabling to evaluate IAD reproducibility. We performed all measurements at the same time of day and before meals in order to avoid BP changes reported to occur following meals . Evaluation of these variables in an elderly population makes this study even more unique as IAD data are scarce in this age group.…”

Section: Study Strengthsmentioning

confidence: 99%

“…We performed all measurements at the same time of day and before meals in order to avoid BP changes reported to occur following meals. 26,27 Evaluation of these variables in an elderly population makes this study even more unique as IAD data are scarce in this age group.…”

Section: Study Strengthsmentioning

confidence: 99%

Inter‐Arm Blood Pressure Difference in Hospitalized Elderly Patients—Is It Consistent?

Grossman

Weiss

Beloosesky

et al. 2014

J of Clinical Hypertension

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6Inter-arm blood pressure difference (IAD) is recognized as a risk factor for cardiovascular mortality. Its reproducibility in the elderly is unknown. The authors determined the prevalence and reproducibility of IAD in hospitalized elderly patients. Blood pressure was measured simultaneously in both arms on two different days in elderly individuals hospitalized in a geriatric ward. The study included 364 elderly patients (mean age, 85AE5 years). Eighty-four patients (23%) had systolic IAD >10 and 62 patients (17%) had diastolic IAD >10 mm Hg. A total of 319 patients had two blood pressure measurements. Systolic and diastolic IAD remained in the same category in 203 (64%) and 231 (72%) patients, respectively. Correlations of systolic and diastolic IAD between the two measurements were poor. Consistency was not affected by age, body mass index, comorbidities, or treatment. IAD is extremely common in hospitalized elderly patients, but, because of poor consistency, its clinical significance in this population is uncertain.

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“…ABPM can detect postprandial hypotension and evaluate its frequency, severity, duration, and relationship to drug intake and symptoms [O'Brien et al 2013]. Several studies have used ABPM to investigate the prevalence and clinical implicance of postprandial hypotension [Kohara et al 1998[Kohara et al , 1999Puisieux et al 2000;Salvioli et al 1996;Grodzicki et al 1998;Vloet et al 2005;Zanasi et al 2012]. The prevalence of postprandial hypotension, as detected by ABPM, is greater in symptomatic elderly patients than in controls [Puisieux et al 2000].…”

Section: Evaluation Of Postprandial Blood Pressurementioning

confidence: 99%

Utility of home blood pressure monitoring to evaluate postprandial blood pressure in treated hypertensive patients

Alfie

2015

Therapeutic Advances in Cardiovascular Disease

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Postprandial hypotension, defined as a fall in systolic blood pressure (SBP) of 20 mmHg or greater within 2 hours after a meal, is a risk factor for stroke, coronary events and mortality. The clinical suspicion is typically raised by episodes of postprandial syncope or falls, whereas asymptomatic postprandial hypotension is mostly neglected. The magnitude of the postprandial fall in SBP, as detected by 24-hour recording in apparently healthy middle-aged to elderly subjects, was proportional to the severity of the silent cerebrovascular damage. Postprandial hypotension can also be detected by self-measured blood pressure before and within 2 hours after meals using automatic devices. The review highlights the value of home blood pressure monitoring (HBPM) as a screening test for asymptomatic postprandial hypotension in hypertensive patients. Using a HBPM protocol that included duplicated blood pressure measurements before and after three consecutive lunches, we detected unsuspected postprandial hypotension in 27.4% of the 230 hypertensive patients screened. The prevalence of postprandial hypotension was 13.2% in controlled and 42.2% in uncontrolled hypertensive patients (p < 0.001), raising the dilemma of further lowering blood pressure in the setting of postprandial hypotension. The inclusion of preprandial and postprandial measurements in the protocol of HBPM is useful to identify hypertensive patients with postprandial hypotension and may guide adjustments in antihypertensive treatment according to postprandial blood pressure.

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

Abstract: 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.

Cited by 25 publications

References 27 publications

Predialysis hypotension is not a predictor for mortality in long-term hemodialysis patients: insight from a single-center observational study

Predialysis hypotension is not a predictor for mortality in long-term hemodialysis patients: insight from a single-center observational study

Inter‐Arm Blood Pressure Difference in Hospitalized Elderly Patients—Is It Consistent?

Utility of home blood pressure monitoring to evaluate postprandial blood pressure in treated hypertensive patients

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