Intraindividual Reproducibility of Postprandial Hypotension

Background: Postprandial hypotension (PPH) is increasingly recognized as a common cause of falls and syncopes in the elderly. The diagnosis of PPH is based on the measurement of meal-induced blood pressure (BP) changes. Although the problem of intraindividual reproducibility of PPH is of clinical importance, it has not been extensively studied. Objective: To assess the intraindividual reproducibility of PPH. Methods: 50 patients (42 women and 8 males, 83 ± 8 years) were included in the study. To evaluate PPH, we measured the BP before and every 15 min for 2 h after the start of a standardized mixed meal. The PPH was defined as a decrease in systolic BP of 20 mm Hg or more. Three sets of BP were obtained for each subject on 2 successive days: (1) between 08.00 and 10.00 h and (2) between 16.00 and 18.00 h on the 1st day and (3) between 08.00 and 10.00 h on the 2nd day. Results: 32 participants (64%) experienced PPH on at least one test. Among them, 19 (38%) had PPH on the first test, 16 (32%) had PPH on the second test, and 21 (42%) had PPH on the third test. The intraindividual reproducibility of PPH was good when the results of the two morning tests were compared together (kappa coefficient = 0.6), but was low when the morning test results were compared with the afternoon test results of the 1st day (kappa coefficient = 0.1). Conclusions: Because of the good reproducibility of postprandial BP changes, we conclude that the diagnosis of PPH may be based on a single standardized test. However, the test must be performed under circumstances (time of the meal, medications) similar to those in which the symptoms occurred.