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Orthostatic (Postural) and Postprandial Hypotension in Older Adults

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Geriatric Medicine

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Abstract

Older adults are at risk for developing orthostatic (postural) hypotension, which is a significant reduction in blood pressure upon standing, and postprandial hypotension, which is a drop in blood pressure after meals [1, 2]. It is recommended that the clinicians have an increased awareness about these geriatric hypotensive syndromes and perform both symptoms screening and serial measurements of blood pressure and heart rate to diagnose these conditions to decrease the significant morbidity and mortality associated with orthostatic and postprandial hypotension [8, 31, 56, 57].

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References

  1. Applegate WB, Davis BR, Black HR, et al. Prevalence of postural hypotension at baseline in the Systolic Hypertension in the Elderly Program (SHEP) cohort. J Am Geriatr Soc. 1991;39:1057–64.

    Article  CAS  PubMed  Google Scholar 

  2. Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21:69–72.

    Article  PubMed  Google Scholar 

  3. Luciano GL, Brennan MJ, Rothberg MB. Postprandial hypotension. Am J Med. 2010;123(3):281.e1–6. https://doi.org/10.1016/j.amjmed.2009.06.026.

    Article  PubMed  Google Scholar 

  4. Jansen RW, Connelly CM, Kelly-Gagnon MM, et al. Postprandial hypotension in elderly patients with unexplained syncope. Arch Intern Med. 1995;155:945–52.

    Article  CAS  PubMed  Google Scholar 

  5. Puisieux F, Bulckaen H, Fauchais AL, Drumez S, Salomez-Granier F, Dewailly P. Ambulatory blood pressure monitoring and postprandial hypotension in elderly persons with falls or syncopes. J Gerontol Ser A Biol Sci Med Sci. 2000;55:M535–40.

    Article  CAS  Google Scholar 

  6. Pham H, Phillips LK, Jones KL. Acute effects of nutritive and non-nutritive sweeteners on postprandial blood pressure. Nutrients. 2019;11(8):1717. https://doi.org/10.3390/nu11081717.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Rutan GH, Hermanson B, Bild DE, Kittner SJ, LaBaw F, Tell GS. Orthostatic hypotension in older adults. The Cardiovascular Health Study. CHS Collaborative Research Group. Hypertension. 1992;19(6 Pt 1):508.

    Article  CAS  PubMed  Google Scholar 

  8. Van Hateren KJ, Kleefstra N, Blanker MH, Ubink-Veltmaat LJ, Groenier KH, Houweling ST, Kamper AM, van der Meer K, Bilo HJ. Orthostatic hypotension, diabetes, and falling in older patients: a cross-sectional study. Br J Gen Pract. 2012;62(603):e696–702.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ong HL, Abdin E, Seow E, et al. Prevalence and associative factors of orthostatic hypotension in older adults: results from the well-being of the Singapore Elderly (WiSE) study. Arch Gerontol Geriatr. 2017;72:146–52. https://doi.org/10.1016/j.archger.2017.06.004.

    Article  PubMed  Google Scholar 

  10. Kocyigit SE, Soysal P, Bulut EA, Aydin AE, Dokuzlar O, Isik AT. What is the relationship between frailty and orthostatic hypotension in older adults? J Geriatr Cardiol. 2019;16(3):272–9. https://doi.org/10.11909/j.issn.1671-5411.2019.03.005.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Valbusa F, Labat C, Salvi P, et al. Orthostatic hypotension in very old individuals living in nursing homes: the PARTAGE study. J Hypertens. 2012;30(1):53–60. https://doi.org/10.1097/HJH.0b013e32834d3d73.

    Article  CAS  PubMed  Google Scholar 

  12. Hommel A, Faber MJ, Weerkamp NJ, van Dijk JG, Bloem BR, Koopmans RT. Prevalence and prescribed treatments of orthostatic hypotension in institutionalized patients with Parkinson’s disease. J Parkinsons Dis. 2016;6(4):805–10. https://doi.org/10.3233/JPD-160853.

    Article  CAS  PubMed  Google Scholar 

  13. Trahair LG, Horowitz M, Jones KL. Postprandial hypotension: a systematic review. J Am Med Dir Assoc. 2014;15:394–409.

    Article  PubMed  Google Scholar 

  14. Schoevaerdts D, Iacovelli M, Toussaint E, Sibille FX, de Saint-Hubert M, Cremer G. Prevalence and risk factors of postprandial hypotension among elderly people admitted in a geriatric evaluation and management unit: an observational study. J Nutr Health Aging. 2019;23(10):1026–33. https://doi.org/10.1007/s12603-019-1271-1.

    Article  CAS  PubMed  Google Scholar 

  15. Sato K, Sugiura T, Ohte N, Dohi Y. Postprandial hypotension in older people receiving tube feeding through gastrostomy. Geriatr Gerontol Int. 2018;18(10):1474–8. https://doi.org/10.1111/ggi.13515.

    Article  PubMed  Google Scholar 

  16. Benarroch EE. The arterial baroreflex: functional organization and involvement in neurologic disease. Neurology. 2008;71:1733–8.

    Article  PubMed  Google Scholar 

  17. Thomas GD. Neural control of the circulation. Adv Physiol Educ. 2011;35:28–32.

    Article  PubMed  Google Scholar 

  18. Chisholm P, Anpalahan M. Orthostatic hypotension: pathophysiology, assessment, treatment and the paradox of supine hypertension. Intern Med J. 2017;47(4):370–9. https://doi.org/10.1111/imj.13171.

    Article  PubMed  Google Scholar 

  19. Bueno-Cavanillas A, Padilla-Ruiz F, Jimenez-Moleon JJ, et al. Risk factors in falls among the elderly according to extrinsic and intrinsic precipitating causes. Eur J Epidemiol. 2000;16:849–59.

    Article  CAS  PubMed  Google Scholar 

  20. de la Iglesia B, Ong AC, Potter JF, Metcalf AK, Myint PK. Predictors of orthostatic hypotension in patients attending a transient ischemic attack clinic: database study. Blood Press. 2013 (Epub 2012 Nov 1);22(2):120–7.

    Google Scholar 

  21. Metzler M, Duerr S, Granata R, Krismer F, Robertson D, Wenning GK. Neurogenic orthostatic hypotension: pathophysiology, evaluation, and management. J Neurol. 2013 (Epub 2012 Nov 20);260(9):2212.

    Google Scholar 

  22. Coon EA, Cutsforth-Gregory JK, Benarroch EE. Neuropathology of autonomic dysfunction in synucleinopathies. Mov Disord. 2018;33(3):349–58. https://doi.org/10.1002/mds.27186.

    Article  PubMed  Google Scholar 

  23. Pfeiffer RF. Management of autonomic dysfunction in Parkinson’s disease. Semin Neurol. 2017;37(2):176–85. https://doi.org/10.1055/s-0037-1601568.

    Article  PubMed  Google Scholar 

  24. Malik RA. The pathology of human diabetic neuropathy. Diabetes. 1997;46(Suppl 2):S50.

    Article  CAS  PubMed  Google Scholar 

  25. Kles KA, Vinik AI. Pathophysiology and treatment of diabetic peripheral neuropathy: the case for diabetic neurovascular function as an essential component. Curr Diabetes Rev. 2006;2(2):131.

    Article  PubMed  Google Scholar 

  26. Isik AT, Kocyigit SE, Smith L, Aydin AE, Soysal P. A comparison of the prevalence of orthostatic hypotension between older patients with Alzheimer’s disease, Lewy body dementia, and without dementia. Exp Gerontol. 2019;124:110628. https://doi.org/10.1016/j.exger.2019.06.001.

    Article  PubMed  Google Scholar 

  27. Phillips PA, Rolls BJ, Ledingham JG, Forsling ML, Morton JJ, Crowe MJ, Wollner L. Reduced thirst after water deprivation in healthy elderly men. N Engl J Med. 1984;311(12):753.

    Article  CAS  PubMed  Google Scholar 

  28. Arbogast SD, Alshekhlee AM, Hussain Z, et al. Hypotension unawareness in profound orthostatic hypotension. Am J Med. 2009;122(6):574–80.

    Article  PubMed  Google Scholar 

  29. Tipton PW, Cheshire WP. Mechanisms underlying unawareness of neurogenic orthostatic hypotension. Clin Auton Res. 2020; https://doi.org/10.1007/s10286-020-00679-0.

  30. van Gerpen J, Al-Shaikh RH, Tipton PW, et al. Progressive supranuclear palsy is not associated with neurogenic orthostatic hypotension. Neurology. 2019;93(14):e1339–47.

    PubMed  Google Scholar 

  31. Pavelić A, Krbot Skorić M, Crnošija L, Habek M. Postprandial hypotension in neurological disorders: systematic review and meta-analysis. Clin Auton Res. 2017;27(4):263–71. https://doi.org/10.1007/s10286-017-0440-8.

    Article  PubMed  Google Scholar 

  32. Umehara T, Nakahara A, Matsuno H, Toyoda C, Oka H. Predictors of postprandial hypotension in elderly patients with de novo Parkinson’s disease. J Neural Transm. 2016;123(11):1331–9. https://doi.org/10.1007/s00702-016-1594-6.

    Article  PubMed  Google Scholar 

  33. Gibbons CH, Schmidt P, Biaggioni I, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol. 2017;264(8):1567–82. https://doi.org/10.1007/s00415-016-8375-x.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Brignole M, Alboni P, Benditt DG, Bergfeldt L, Blanc JJ, Bloch Thomsen PE, et al. Guidelines on management (diagnosis and treatment) of syncope – update 2004. Europace. 2004;6:467–537.

    Article  PubMed  Google Scholar 

  35. Shibao C, Lipsitz LA, Biaggioni I. ASH position paper: evaluation and treatment of orthostatic hypotension. J Clin Hypertens. 2013;15:147–53.

    Article  CAS  Google Scholar 

  36. Finucane C, O’Connell MD, Fan CW, Savva GM, Soraghan CJ, Nolan H, et al. Age-related normative changes in phasic orthostatic blood pressure in a large population study: findings from The Irish Longitudinal Study on Ageing (TILDA). Circulation. 2014;130:1780–9.

    Article  PubMed  Google Scholar 

  37. Piha SJ. Age-related diminution of the cardiovascular autonomic responses: diagnostic problems in the elderly. Clin Physiol. 1993;13:507–17.

    Article  CAS  PubMed  Google Scholar 

  38. Furukawa K, Suzuki T, Ishiguro H, et al. Prevention of postprandial hypotension-related syncope by caffeine in a patient with long-standing diabetes mellitus. Endocr J. 2020; https://doi.org/10.1507/endocrj.EJ19-0370.

  39. Wieling W, van Dijk N, Thijs RD, de Lange FJ, Krediet CT, Halliwill JR. Physical countermeasures to increase orthostatic tolerance. J Intern Med. 2015;277:69–82.

    Article  CAS  PubMed  Google Scholar 

  40. Podoleanu C, Maggi R, Brignole M, Croci F, Incze A, Solano A, et al. Lower limb and abdominal compression bandages prevent progressive orthostatic hypotension in elderly persons: a randomized single-blind controlled study. J Am Coll Cardiol. 2006;48:1425–32.

    Article  PubMed  Google Scholar 

  41. Newton JL, Frith J. The efficacy of nonpharmacologic intervention for orthostatic hypotension associated with aging. Neurology. 2018;91(7):e652–6. https://doi.org/10.1212/WNL.0000000000005994.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Fan CW, Walsh C, Cunningham CJ. The effect of sleeping with the head of the bed elevated six inches on elderly patients with orthostatic hypotension: an open randomised controlled trial. Age Ageing. 2011;40:187–92.

    Article  PubMed  Google Scholar 

  43. Wieling W, Raj SR, Thijs RD. Are small observational studies sufficient evidence for a recommendation of head-up sleeping in all patients with debilitating orthostatic hypotension? MacLean and Allen revisited after 70 years. Clin Auton Res. 2009;19:8–12.

    Article  PubMed  Google Scholar 

  44. Saladini F, Di Marco A, Palatini P. Autonomic dysfunction: how to identify and when to treat? High Blood Press Cardiovasc Prev. 2016;23:237–43. https://doi.org/10.1007/s40292-016-0162-3.

    Article  PubMed  Google Scholar 

  45. Sinn DI, Gibbons CH. Pathophysiology and treatment of orthostatic hypotension in parkinsonian disorders. Curr Treat Options Neurol. 2016;18(6):28. https://doi.org/10.1007/s11940-016-0410-9.

    Article  PubMed  Google Scholar 

  46. Chen JJ, Han Y, Tang J, Portillo I, Hauser RA, Dashtipour K. Standing and supine blood pressure outcomes associated with droxidopa and midodrine in patients with neurogenic orthostatic hypotension: a Bayesian meta-analysis and mixed treatment comparison of randomized trials. Ann Pharmacother. 2018;52(12):1182.

    Article  CAS  PubMed  Google Scholar 

  47. Byun JI, Moon J, Kim DY, et al. Efficacy of single or combined midodrine and pyridostigmine in orthostatic hypotension. Neurology. 2017;89(10):1078–86. https://doi.org/10.1212/WNL.0000000000004340.

    Article  CAS  PubMed  Google Scholar 

  48. Byun JI, Kim DY, Moon J, et al. Efficacy of atomoxetine versus midodrine for neurogenic orthostatic hypotension [published correction appears in Ann Clin Transl Neurol. 2020;7(3):402]. Ann Clin Transl Neurol. 2020;7(1):112–20. https://doi.org/10.1002/acn3.50968.

    Article  CAS  PubMed  Google Scholar 

  49. Gentilcore D, Jones KL, O’Donovan DG, Horowitz M. Postprandial hypotension – novel insights into pathophysiology and therapeutic implications. Curr Vasc Pharmacol. 2006;4(2):161–71. https://doi.org/10.2174/157016106776359826.

    Article  CAS  PubMed  Google Scholar 

  50. Ong AC, Myint PK, Potter JF. Pharmacological treatment of postprandial reductions in blood pressure: a systematic review. J Am Geriatr Soc. 2014;62(4):649–61. https://doi.org/10.1111/jgs.12728.

    Article  PubMed  Google Scholar 

  51. Grobéty B, Grasser EK, Yepuri G, Dulloo AG, Montani JP. Postprandial hypotension in older adults: can it be prevented by drinking water before the meal? Clin Nutr. 2015;34(5):885–91. https://doi.org/10.1016/j.clnu.2014.09.009.

    Article  PubMed  Google Scholar 

  52. Alagiakrishnan, K and Mah, D in Postprandial Hypotension pp 9–21, Hypotensive syndromes in geriatric patients, https://doi.org/10.1007/978-3-030-30332-7_2

  53. Zhang J, Guo L. Effectiveness of acarbose in treating elderly patients with diabetes with postprandial hypotension. J Invest Med. 2017;65(4):772–83. https://doi.org/10.1136/jim-2016-000295.

    Article  Google Scholar 

  54. Madden KM, Harris DE, Meneilly GS. Attenuation of postprandial hypotension with acarbose in older adults with type 2 diabetes mellitus. J Am Geriatr Soc. 2015;63(7):1484–6. https://doi.org/10.1111/jgs.13503.

    Article  PubMed  Google Scholar 

  55. Fedorowski A, Stavenow L, Hedblad B, Berglund G, Nilsson PM, Melander O. Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Preventive Project). Eur Heart J. 2010 Jan (Epub 2009 Aug 20);31(1):85–91.

    Google Scholar 

  56. Kruit MC, Thijs RD, Ferrari MD, Launer LJ, van Buchem MA, van Dijk JG. Syncope and orthostatic intolerance increase risk of brain lesions in migraineurs and controls. Neurology. 2013 May (Epub 2013 Apr 24);80(21):1958–65.

    Google Scholar 

  57. Tzur I, Barchel D, Khateb Z, Swarka M, Izhakian S, Gorelik O. Delayed versus classic orthostatic hypotension: clinical and prognostic implications. Blood Press. 2020; https://doi.org/10.1080/08037051.2020.1733389.

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Authors and Affiliations

  1. Geriatric Medicine, David Geffen School of Medicine, Los Angeles, CA, USA

    Gabriela Sauder

Authors
  1. Gabriela Sauder
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Correspondence to Gabriela Sauder .

Editor information

Editors and Affiliations

  1. California Association of Long Term Care Medicine, Newbury Park, CA, USA

    Michael R. Wasserman

  2. Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA

    Debra Bakerjian

  3. Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA

    Sunny Linnebur

  4. Division of Geriatrics, SUNY Upstate Medical University, Syracuse, NY, USA

    Sharon Brangman

  5. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Matteo Cesari

  6. Section of Geriatric Medicine, Division of Internal Medicine, Department of Medicine, Cedars-Sinai, Beverly Hills, CA, USA

    Sonja Rosen

Section Editor information

  1. California Association of Long Term Care Medicine, Newbury Park, CA, USA

    Michael R. Wasserman M.D., CMD

  2. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Matteo Cesari MD, PhD

  3. Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Matteo Cesari MD, PhD

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Sauder, G. (2024). Orthostatic (Postural) and Postprandial Hypotension in Older Adults. In: Wasserman, M.R., Bakerjian, D., Linnebur, S., Brangman, S., Cesari, M., Rosen, S. (eds) Geriatric Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-74720-6_30

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  • DOI: https://doi.org/10.1007/978-3-030-74720-6_30

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