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(Hypertension. 1999;33:565-568.)
© 1999 American Heart Association, Inc.

Scientific Contributions

Postprandial Hypotension Is Associated With Asymptomatic Cerebrovascular Damage in Essential Hypertensive Patients

Katsuhiko Kohara; Yinong Jiang; Michiya Igase; Yasunori Takata; Tomikazu Fukuoka; Takafumi Okura; Yutaka Kitami; Kunio Hiwada

From the Department of Geriatric Medicine (K.K.), Second Department of Internal Medicine, Ehime University School of Medicine, Onsen-gun, Ehime, Japan.

Correspondence to Katsuhiko Kohara, MD, Department of Geriatric Medicine, Ehime University School of Medicine, Onsen-gun, Ehime 791-0295, Japan. E-mail koharak{at}m.ehime-u.ac.jp

Abstract—To elucidate the relationship between postprandial hypotension (PPH) and asymptomatic cerebrovascular damage, we evaluated changes in blood pressure after a meal by 24-hour blood pressure monitoring in 70 hospitalized essential hypertensive patients aged 50 years. They received a diet containing standard nutritional ingredients with 120 mmol (7 g) NaCl and were free from medication for at least 1 week. PPH was defined as the mean reduction of systolic blood pressure during 2 hours after a meal. Patients were divided into three groups according to mean values of PPH after 3 meals: PPH-1 (n=16, 5 mm HgPPH<10 mm Hg), PPH-2 (n=18, PPH10 mm Hg), and normal (n=36, PPH<5 mm Hg). As asymptomatic cerebrovascular damage, lacunae and leukoaraiosis were evaluated by magnetic resonance imaging. PPH did not correlate with daytime or nighttime blood pressure or the nondipper phenomenon; however, PPH was significantly related to asymptomatic cerebrovascular damage. The prevalence of lacunae in the normal, PPH-1, and PPH-2 groups was 44%, 69%, and 83%, respectively (²=8.22, P<0.05). The number of lacunae in the normal, PPH-1, and PPH-2 groups was 1.0±1.3, 1.3±1.2, and 1.9±1.4, respectively (F[2,67]=3.2, P<0.05). The prevalence of advanced leukoaraiosis in the normal, PPH-1, and PPH-2 groups was 44%, 50%, and 83%, respectively (²=7.63, P<0.05). Severity score of leukoaraiosis in the normal, PPH-1, and PPH-2 groups was 1.5±0.7, 1.7±0.8, and 2.1±0.7, respectively (F[2,67]=4.3, P<0.05). These findings indicate that elderly hypertensive patients with marked PPH should be considered to have advanced cerebrovascular damage even in the absence of abnormal neurological findings.

Key Words: blood pressure monitoring • elderly • hypotension, postprandial • lacuna • leukoaraiosis • blood pressure variability

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