Uncontrolled Hypertension is Associated with Postprandial Hypotension

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Abstract

Background: In a previous study that incorporated post-lunch measurements to the conventional scheme of home-based blood pressure monitoring, we detected postprandial hypotension in about a quarter of hypertensive patients.
Objectives: The aim of this study was to compare the postprandial change of systolic blood pressure, and the corresponding chronotropic response, associated to the control of hypertension.
Methods: We prospectively evaluated 140 treated hypertensive patients, aged over 40 years, with home-based blood pressure monitoring. The control of hypertension was based on the average morning and evening blood pressure, considering 135/85 mmHg as cutoff value. Postprandial hypotension was defined as a drop in systolic blood pressure equal to or greater than 20 mmHg 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 controlled hypertensive patients (r=-0.24; p=0.035), and a not significant correlation in uncontrolled patients. On the multiple linear regression analysis, lack of blood pressure control (beta=0.26, p=0.002) and female gender (beta=0.22; p<0.001) were significant predictors of a postprandial drop in systolic blood pressure, without a significant influence of age or number of antihypertensive drugs.

Conclusion: Lack of blood pressure control was associated with an abnormal postprandial circulatory response that predisposes to hypotension.