Uncontrolled Hypertension is Associated with Postprandial Hypotension

Abstract

Background: In a previous study that incorporated post-lunch measurements to the conventional scheme of home-based bloodpressure monitoring, we detected postprandial hypotension in about a quarter of hypertensive patients. The coexistence ofhypertension with hypotension poses a therapeutic dilemma, suggesting that the control of hypertension might attenuatepostprandial hypotension.Objectives: The aim of this study was to compare the postprandial change of systolic blood pressure, and the correspondingchronotropic response, associated to the control of hypertension.Methods: We prospectively evaluated 140 treated hypertensive patients, aged over 40 years, with home-based blood pressuremonitoring. The control of hypertension was based on the average morning and evening blood pressure, considering 135/85mmHg as cutoff value. Postprandial hypotension was defined as a drop in systolic blood pressure equal to or greater than 20mmHg with respect to the preprandial value in at least one of three lunches.Results: Postprandial hypotension was found in 13.2% (n=10) of patients with controlled hypertension and in 42.2% (n=27)with uncontrolled hypertension (p<0.001). After lunch, the average decrease of systolic blood pressure was 9.5±10.5 mmHg(6.4%±7.8%) in patients with uncontrolled hypertension and 3.2±7.8 mmHg (2.6%±6.5%) in those with controlled hypertension(p<0.001), with no significant difference in the chronotropic response. After stratifying the patients by hypertension control, the postprandial response of heart rate and systolic blood pressure showed a significant inverse correlation in controlledhypertensive patients (r=-0.24; p=0.035), and a not significant correlation in uncontrolled patients. On the multiplelinear regression analysis, lack of blood pressure control (beta=0.26, p=0.002) and female gender (beta=0.22; p<0.001) weresignificant predictors of a postprandial drop in systolic blood pressure, without a significant influence of age or number ofantihypertensive drugs.Conclusion: Lack of blood pressure control was associated with an abnormal postprandial circulatory response that predisposesto hypotension.