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Postprandial hypotension in elderly patients with unexplained syncope.
Arch Intern Med. 1995 May 08; 155(9):945-52.AI

Abstract

BACKGROUND

Syncope in older patients may be caused by a variety of disorders, including hypotension, but frequently remains unexplained. Postprandial hypotension is a common disorder of blood pressure regulation in the elderly.

OBJECTIVE

To determine the pathogenic mechanisms and potential role of postprandial hypotension in elderly patients with otherwise unexplained syncope.

METHODS

We studied 16 elderly patients with unexplained syncope and nine elderly controls. Blood pressure, heart rate, forearm vascular resistance, plasma norepinephrine level, and cardiac and splanchnic blood volumes were measured before and after a 1680-kJ meal.

RESULTS

Eight elderly patients with syncope had postprandial hypotension, with a decline in supine mean arterial blood pressure of 17 +/- 2 mm Hg after a meal (P < .001). The blood pressure remained unchanged after the meal in the other patients with syncope and the controls. In patients with postprandial hypotension, systemic vascular resistance fell after the meal, while it remained unchanged in the other groups. Heart rate and plasma norepinephrine level increased to a similar extent in all three groups. Forearm vascular resistance increased only in the control subjects. Splanchnic blood volume increased by 26% (P < .01) in patients with syncope who had postprandial hypotension and by 22% (P < .01) in control subjects. Splanchnic blood volume remained unchanged in the patients with syncope without postprandial hypotension.

CONCLUSIONS

Postprandial hypotension may be an important causative factor in elderly patients with unexplained syncope. The evaluation of syncope in elderly patients should therefore include blood pressure measurements surrounding a meal. Elderly patients with syncope who have postprandial hypotension fail to maintain systemic vascular resistance, probably because of splanchnic blood pooling without a compensatory increase in peripheral vascular resistance.

Authors+Show Affiliations

Hebrew Rehabilitation Center for Aged, Beth Israel Hospital, Boston, Mass, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

7726703

Citation

Jansen, R W., et al. "Postprandial Hypotension in Elderly Patients With Unexplained Syncope." Archives of Internal Medicine, vol. 155, no. 9, 1995, pp. 945-52.
Jansen RW, Connelly CM, Kelley-Gagnon MM, et al. Postprandial hypotension in elderly patients with unexplained syncope. Arch Intern Med. 1995;155(9):945-52.
Jansen, R. W., Connelly, C. M., Kelley-Gagnon, M. M., Parker, J. A., & Lipsitz, L. A. (1995). Postprandial hypotension in elderly patients with unexplained syncope. Archives of Internal Medicine, 155(9), 945-52.
Jansen RW, et al. Postprandial Hypotension in Elderly Patients With Unexplained Syncope. Arch Intern Med. 1995 May 8;155(9):945-52. PubMed PMID: 7726703.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Postprandial hypotension in elderly patients with unexplained syncope. AU - Jansen,R W, AU - Connelly,C M, AU - Kelley-Gagnon,M M, AU - Parker,J A, AU - Lipsitz,L A, PY - 1995/5/8/pubmed PY - 1995/5/8/medline PY - 1995/5/8/entrez SP - 945 EP - 52 JF - Archives of internal medicine JO - Arch Intern Med VL - 155 IS - 9 N2 - BACKGROUND: Syncope in older patients may be caused by a variety of disorders, including hypotension, but frequently remains unexplained. Postprandial hypotension is a common disorder of blood pressure regulation in the elderly. OBJECTIVE: To determine the pathogenic mechanisms and potential role of postprandial hypotension in elderly patients with otherwise unexplained syncope. METHODS: We studied 16 elderly patients with unexplained syncope and nine elderly controls. Blood pressure, heart rate, forearm vascular resistance, plasma norepinephrine level, and cardiac and splanchnic blood volumes were measured before and after a 1680-kJ meal. RESULTS: Eight elderly patients with syncope had postprandial hypotension, with a decline in supine mean arterial blood pressure of 17 +/- 2 mm Hg after a meal (P < .001). The blood pressure remained unchanged after the meal in the other patients with syncope and the controls. In patients with postprandial hypotension, systemic vascular resistance fell after the meal, while it remained unchanged in the other groups. Heart rate and plasma norepinephrine level increased to a similar extent in all three groups. Forearm vascular resistance increased only in the control subjects. Splanchnic blood volume increased by 26% (P < .01) in patients with syncope who had postprandial hypotension and by 22% (P < .01) in control subjects. Splanchnic blood volume remained unchanged in the patients with syncope without postprandial hypotension. CONCLUSIONS: Postprandial hypotension may be an important causative factor in elderly patients with unexplained syncope. The evaluation of syncope in elderly patients should therefore include blood pressure measurements surrounding a meal. Elderly patients with syncope who have postprandial hypotension fail to maintain systemic vascular resistance, probably because of splanchnic blood pooling without a compensatory increase in peripheral vascular resistance. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/7726703/Postprandial_hypotension_in_elderly_patients_with_unexplained_syncope_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/vol/155/pg/945 DB - PRIME DP - Unbound Medicine ER -