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Effects of postprandial walking exercise on meal-related hypotension in frail elderly patients

1999; Elsevier BV; Volume: 84; Issue: 9 Linguagem: Inglês

10.1016/s0002-9149(99)00520-2

1879-1913

Amitai S Oberman, Randall K. Harada, Margaret Gagnon, Dan K. Kiely, Lewis A. Lipsitz,

Cardiovascular Health and Disease Prevention

Postprandial hypotension (PPH) accounts for approximately 8% of syncopal episodes in elderly patients 1 Lipsitz L.A. Pluchino P.C. Wei J.Y. Minaker K.L. Rowe J.W. Cardiovascular and norepinephrine responses after meal consumption in elderly (older than 75 years) persons with postprandial hypotension and syncope. Am J Cardiol. 1986; 58: 810-915 Abstract Full Text PDF PubMed Scopus (87) Google Scholar ; 50% of these episodes cannot be explained by conventional in-hospital evaluations. 2 Jansen R.W.M.M. Connelly C.M. Kelley-Gagnon M.M. Parker J.A. Lipsitz L.A. Postprandial hypotension in elderly patients with unexplained syncope. Arch Intern Med. 1995; 155: 945-952 Crossref PubMed Scopus (90) Google Scholar Nearly all elderly nursing home residents experience postprandial decreases in blood pressure (BP) and 24% to 36% have a systolic BP decrease of >20 mm Hg within 75 minutes of eating a meal. 3 Aronow W.S. Ahn C. Postprandial hypotension in 499 elderly persons in a long-term health care facility. J Am Geriatr Soc. 1994; 42: 930-932 Crossref PubMed Scopus (110) Google Scholar , 4 Vaitkevicius P.V. Esserwein D.M. Maynard A.K. O’Connor F.C. Fleg J.L. Frequency and importance of postprandial blood pressure reduction in elderly nursing-home patients. Ann Intern Med. 1991; 115: 865-870 Crossref PubMed Scopus (98) Google Scholar In these patients, a marked postprandial reduction in systolic BP is associated with an increased incidence of falls, syncope, new coronary events, new strokes, and total mortality at long-term follow-up. 5 Aronow W.S. Ahn C. Association of postprandial hypotension with incidence of falls, syncope, coronary events, stroke, and total mortality at 29-month follow-up in 499 older nursing home residents. J Am Geriatr Soc. 1997; 45: 1051-1053 Crossref PubMed Scopus (134) Google Scholar Various pharmacologic and nonpharmacologic interventions for the treatment of symptomatic PPH have been studied, but results are conflicting. 6 Jansen R.W.M.M. Lipsitz L.A. Postprandial hypotension epidemiology, pathophysiology and clinical management. Ann Intern Med. 1995; 122: 286-295 Crossref PubMed Scopus (349) Google Scholar Splanchnic blood pooling appears to be an important initial event in the development of PPH. Because exercise is associated with an increase in heart rate (HR), cardiac output, BP, and redistribution of blood from the splanchnic circulation to exercising muscles, 7 Puvi-Rajasingham S. Wijeyekoon B. Natarajan P. Mathias C.J. Systemic and regional (including superior mesenteric) haemodynamic responses during supine exercise while fasted and fed in normal man. Clin Autonom Res. 1997; 7: 149-154 Crossref PubMed Scopus (10) Google Scholar we hypothesized that postprandial exercise would ameliorate PPH in the elderly. The purpose of this study was to assess the hemodynamic effects of an after meal walk in elderly nursing home residents with PPH.