Elderly who "eat and run" may risk fainting

October 02, 2000

After-meal drop in blood pressure adds to pressure loss with standing

New York, NY -October 3, 2000 - Columbia-Presbyterian researchers have found that for the elderly, eating meals and standing each can cause a drop in blood pressure that, especially when combined, may cause falls or even fainting.

"The reality is that since older people eat and stand up three times a day--this may be the most common reason that older people pass out," says Dr. Mathew Maurer, instructor in the department of medicine at Columbia University College of Physicians and Surgeons. Dr. Maurer and others report in the October 3, 2000 issue of the Annals of Internal Medicine that 22 percent of the functionally independent elderly people tested showed the effects of hypotension after both eating a meal and becoming upright.

Orthostatic hypotension, or a drop in blood pressure upon standing, is associated with a tendency to faint or fall in the elderly. "We know that older people are much more susceptible to hypotension--for instance, a drop in pressure can occur when standing up," says Dr. Maurer. Previous research also demonstrated that blood pressure can also drop in a seated elderly person after a meal. "The effect of eating on blood pressure has been seen almost exclusively in older people. In the news, you may have heard that Senator Strom Thurmond passed out after eating in a restaurant this weekend," Dr. Maurer cites the 97-year-old politician's loss of consciousness as a potential example of the phenomenon.

It was unknown, however, whether this post-meal drop in pressure might magnify the effect of suddenly rising, or simply add to it. Dr. Maurer and colleagues tested this idea by measuring blood pressure in elderly, non-disabled subjects who were strapped to a table that tilted upright, either before or 30 minutes after a carbohydrate-rich warm meal. "We've just shown that the two effects are additive, but not synergistic," says Dr. Maurer. When combined, the effects produced fainting in 22 percent of the participants in the study.

To the elderly, co-author Dr. Daniel Bloomfield, assistant professor of medicine, advises, "If you find yourself lightheaded at times, you should be evaluated for low blood pressure." Dr. Maurer points out, "Although orthostatic hypotension can be treated with elastic stockings or medication, there isn't really a recommended treatment for postprandial hypotension."

Dr. Maurer adds, "While a physician can cursorily assess the tendency for loss of blood pressure in these situations by questioning patients, definitive diagnosis requires thorough testing. This might involve use of postprandial [after-meal] measurement, preferably in conjunction with tilt-table tests like those used in our study."

"Even when a physician measures a drop in blood pressure with standing of only 30 millimeters of mercury, this could become significant when combined with the effect of eating a meal," Dr. Bloomfield comments. Dr. Maurer emphasizes, "Healthcare professionals should be aware that because the elderly eat and stand three times a day, the cumulative risk for fainting can be very high."
The study was funded by a grant from the National Institutes of Health and the American College of Cardiology.

Columbia University Medical Center

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