New Simplified Screening Method for Postprandial Hypotension in Older People

Abstract

Background: Postprandial hypotension (PPH) is an important disorder in the older people that remain underdiagnosed. The reference PPH diagnostic method is too demanding, because blood pressure (BP) needs to be measured 8 times in 2 hours.

Objectives: Our primary objective was to define a new simplified PPH diagnostic method and to evaluate its performances.

Design: We conducted a cross-sectional study.

Setting: Two geriatric rehabilitation units in France.

Participants: 104 patients (70 women, 34 men) with high risk of PPH were included.

Measurements: BP was measured twice before the midday meal in seated position at the table, and every 15 minutes for 90 minutes after the end of the meal. Receiver Operating Characteristic curves were plotted for each postprandial BP measure to determine the best postprandial measure in terms of sensitivity and specificity. The optimal diagnostic threshold was calculated with Youden's index according to BP difference before and after the meal.

Results: A new simplified diagnostic method is proposed: a decrease of at least 10 mmHg systolic BP between BP measures before the meal and 75 minutes after the end of the meal. This new method had a sensitivity of 82% (95%CI 66 - 92) and a specificity of 91% (95%CI 81 - 97).

Conclusion: This new diagnostic method is fast, efficient and suitable for everyday use. It could improve PPH diagnosis in older people. Larger studies are needed to validate it.

Keywords: Postprandial; cardiovascular; diagnostic techniques and procedures; hypotension; older people.