Effects of Postprandial Blood Pressure on Gait Parameters in Older People

Prevalence of postprandial hypotension in older adults: a systematic review and meta-analysis

BACKGROUND

Older adults with postprandial hypotension (PPH) increase susceptibility to falls, syncope, stroke, acute cardiovascular diseases and even death. However, the prevalence of this condition varies significantly across studies. We aimed to determine the prevalence of PPH in older adults.

METHODS

Web of Science, PubMed, Cochrane Library, Embase and CINAHL were searched from their inception until February 2023. Search terms included 'postprandial period', 'hypotension' and 'postprandial hypotension'. Eligible studies were assessed using the Joanna Briggs Institute tool. Meta-analyses were performed among similar selected studies.

RESULTS

Thirteen eligible studies were included, and data from 3,021 participants were pooled. The meta-analysis revealed a PPH prevalence of 40.5% [95% confidence interval (CI): 0.290-0.519] in older adults, and this was prevalent in the community (32.8%, 95% CI: 0.078-0.647, n = 1,594), long-term healthcare facility (39.4%, 95% CI: 0.254-0.610, n = 1,062) and geriatrics department of hospitals (49.3%, 95% CI: 0.357-0.630, n = 365). The pooled results showed significant heterogeneity (I2 > 90%), partially related to the different ages, sex, pre-prandial systolic blood pressure levels of participants, or the different criteria and methodology used to diagnose PPH.

CONCLUSIONS

PPH is a prevalent condition in older adults. Further research is needed to confirm this result, and priority should be given to establishing international consensus on PPH diagnostic criteria and designing its diagnostic procedure.

Non-pharmacological interventions for older adults with postprandial hypotension: A scoping review

BACKGROUND

Older adults frequently suffer from postprandial hypotension, associated with an increased risk of falls, syncope, acute cardiovascular and cerebrovascular diseases, and even death. Researchers use non-pharmacological interventions, but related literature is dispersed and lacks a latest summary.

OBJECTIVE

The aim of this study was to map and examine non-pharmacological interventions currently employed to assist older adults with postprandial hypotension and lay a solid foundation for future studies.

METHODS

This study adhered to the JBI methodology for scoping reviews and preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews. PubMed, Web of Science, Embase, Cochrane Library, CINAHL, SCOPUS, Chinese Biomedical Journal, China National Knowledge Infrastructure, VIP and WAN FANG Data were retrieved from their inception to 1 August 2022.

RESULTS

Two randomized controlled trials and seven quasi-experimental studies were included. Small meals, exercise interventions, fibre with meals, green tea and water therapy have been reported to prevent postprandial hypotension effectively; however, position changes have been reported to have no impact on postprandial blood pressure decrease. Additionally, the blood pressure determination methods and test meals may affect observed trial effects.

CONCLUSION

Large samples and long-term follow-up studies are needed to prove the efficacy and safety of existing non-pharmacological interventions. Future studies should develop a BP determination method based on the postprandial BP decline trajectory induced by a given test meal to improve the reliability of study results.

RELEVANCE TO CLINICAL PRACTICE

This review broadly summarizes existing studies on developing and validating non-pharmacological interventions for older adults with postprandial hypotension. It also analyses special factors that may influence the trial effects. This may provide a useful reference for future research.

What Is the Relationship Between Orthostatic Blood Pressure and Spatiotemporal Gait in Later Life?

BACKGROUND/OBJECTIVES

Little work to date has examined the relationship between gait performance and blood pressure (BP) recovery after standing in later life. The aim of this study is to clarify the association of orthostatic BP with spatiotemporal gait parameters in a large cohort of older people.

DESIGN

Cross-sectional study using multilevel linear regression to ascertain the difference in orthostatic BP patterns across tertiles of gait speed, and linear regression to analyze the association of orthostatic hypotension 30 seconds after standing (OH-30) with specific gait characteristics.

SETTING

The Irish Longitudinal Study on Ageing.

PARTICIPANTS

A total of 4311 community-dwelling adults, aged 50 years or older (mean age = 62.2 years; 54% female), one fifth (n = 791) of whom had OH-30.

MEASUREMENTS

Continuous orthostatic BP was measured during active stand. OH-30 was defined as a drop in systolic BP of 20 mm Hg or more or drop in diastolic BP of 10 mm Hg or more at 30 seconds. Spatiotemporal gait was assessed using the GAITRite system, reporting gait speed, step length, step width, and double support time in both single and dual (cognitive task) conditions.

RESULTS

OH-30 was associated with slower gait speed (β = -3.01; 95% confidence interval [CI] = -4.46 to -1.56) and shorter step length (β = -.73; 95% CI = -1.29 to -.16) in fully adjusted models during single task walking. Similar findings were observed in dual task conditions, in addition to increased double support phase (β = .45; 95% CI = .02-.88). Multilevel models demonstrated that participants in the slowest tertile for gait speed had a significantly larger drop in systolic BP poststanding compared to those with faster gait speeds in single and dual task conditions.

CONCLUSIONS

This study demonstrates that slower recovery of BP after standing is independently associated with poorer gait performance in community-dwelling older adults. Given the adverse outcomes independently associated with OH and gait problems in later life, increasing awareness that they commonly coexist is important, particularly as both are potentially modifiable. J Am Geriatr Soc 68:1286-1292, 2020.

Acute Effects of Nutritive and Non-Nutritive Sweeteners on Postprandial Blood Pressure

Postprandial hypotension (PPH) is under-recognised, but common, particularly in the elderly, and is of clear clinical importance due to both the independent association between PPH and an increase in mortality and lack of effective management for this condition. Following health concerns surrounding excessive consumption of sugar, there has been a trend in the use of low- or non-nutritive sweeteners as an alternative. Due to the lack of literature in this area, we conducted a systematic search to identify studies relevant to the effects of different types of sweeteners on postprandial blood pressure (BP). The BP response to ingestion of sweeteners is generally unaffected in healthy young subjects, however in elderly subjects, glucose induces the greatest decrease in postprandial BP, while the response to sucrose is less pronounced. The limited studies investigating other nutritive and non-nutritive sweeteners have demonstrated minimal or no effect on postprandial BP. Dietary modification by replacing high nutritive sweeteners (glucose, fructose, and sucrose) with low nutritive (d-xylose, xylitol, erythritol, maltose, maltodextrin, and tagatose) and non-nutritive sweeteners may be a simple and effective management strategy for PPH.