Korean Journal of Adult Nursing (성인간호학회지)

Korean Society of Adult Nursing (한국성인간호학회)
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Postprandial Hypotension and Heart Rate Variability in Older Adults

노인의 식후 저혈압과 심박동변이

  • Received : 2012.01.09
  • Accepted : 2012.04.18
  • Published : 2012.04.30
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Abstract

Purpose: A study was designed to compare heart rate variability (HVR) of older adults with postprandial hypotension (PPH) with older adults with no PPH. Methods: The samples were community-dwelling older adults (${\geq}$ 60 years old) with PPH (n=35) and without PPH (n=35). HRV was measured by 10 minutes of electrocardiography using Physiolab 400 and analyzed in time domain (SDNN) and with power spectral analysis in frequency domain (TP, LF, HF, LF/HF). Blood pressure was measured every 15 minutes before and until 120 minutes after the meal. Results: All HRV parameters were lower in the PPH group compared to those with no PPH. Specifically the measures of SDNN, TP, LF, and LF/HF of the PPH group were significantly lower (U=385.0, $p$=.008; U=361.0, $p$=.003; U=375.0, $p$=.005; U=368.0, $p$=.004, respectively). Further, the LF and LF/HF of SBP (${\geq}140$ mmHg) group and the LF/HF of DBP (${\geq}$ 90 mmHg) group were significantly lower ($x^2$=6.33, $p$=.042; $x^2$=33.10, $p$ <.001; $x^2$=11.03, $p$=.004, respectively). Conclusion: These findings indicate that the autonomic nervous functions in persons with PPH are less activated than those persons with no PPH. The findings contribute to an understanding of HRV and the association of autonomic nervous function with the mechanism of PPH.

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References

  1. Aronow, W. S., & Ahn, C. (1994). Postprandial hypotension in 499 elderly persons in a long-term health care facility. Journal of American Geriatrics Society, 42 , 930-932. https://doi.org/10.1111/j.1532-5415.1994.tb06582.x
  2. Carney, R. M., Blumenthal, J. A., Stein, P. K., Watkins, L., Catellier, D., Berkman, L. F., et al. (2001). Depression, heart rate variability, and acute myocardial infarction. Circulation, 104 (17), 2024-2028. https://doi.org/10.1161/hc4201.097834
  3. Cha, M. H., Kim, Y. S., & Choi, J, B. (2004). Analysis of heart rate variability in patients with urgency. Korean Continence Society, 8 , 119-123. https://doi.org/10.5213/jkcs.2004.8.2.119
  4. Faulkner, M. S., Hathaway, D., & Tolley, B. (2003). Cardiovascular autonomic function in healthy adolescents. Heart & Lung, 32 (1), 10-22. https://doi.org/10.1067/mhl.2003.6
  5. Grodzicki, T., Rajzer, M., Fagard, R., O'Brien, E. T., Thijs, L., Clement, D., et al. (1998). Ambulatory blood pressure monitoring and postprandial hypotension in elderly patients with isolated systolic hypertension. Journal of Human Hypertension, 12 (3), 161-165. https://doi.org/10.1038/sj.jhh.1000573
  6. Hellstrom, H. R. (2007). The altered homeostatic theory: A hypothesis proposed to be useful in understanding and preventing ischemic heart disease, hypertension, and diabetes- including reducing the risk of age and atherosclerosis. Medical Hypotheses, 68 (2), 415-433. doi:10.1016/j.mehy.2006.05.031
  7. Huikuri, H. V,. Ylitalo, A,. Pikkujamsa, S. M., Ikäheimo, M. J., Airaksinen, K. E., Rantala, A. O., et al. (1996). Heart rate variability in systemic hypertension. The American Journal of Cardiology, 77 (12), 1073-1077. https://doi.org/10.1016/S0002-9149(96)00135-X
  8. Jansen, R. W., & Lipsitz, L. A. (1995). Postprandial hypotension: epidemiology, pathophysiology, and clinical management. Annals of Internal Medicine, 122 (4), 286-295. https://doi.org/10.7326/0003-4819-122-4-199502150-00009
  9. Jeong, K. S. (2004). Overview of HRV. Korean Journal of Family Medicine, 25 (11), 528-532.
  10. Jian, Z. J., & Zhou, B. Y. (2008). Efficacy and safety of acarbose in the treatment of elderly patients with postprandial hypotension. Chinese Medical Journal, 121 , 2054-2059.
  11. Jones, K. L., Macintosh, C., Su, Y. C., Wells, F., Chapman, I. M., Tonkin, A., et al. (2001). Guar gum reduces postprandial hypotension in older people. Journal of the American Geriatrics Society, 49 , 162-167. https://doi.org/10.1046/j.1532-5415.2001.49037.x
  12. Joo, S., Kim, K. S., Yook, D. S., & Lee, J. W. (2005). Correlation of the left ventricular diastolic function and the heart rate variability in patients with acute myocardial infarction. The Korean Association of Internal Medicine, 69 (2), 167- 176.
  13. Kawaguchi, R., Nomura, M., Miyajima, H., Nakaya, Y., Mouri, S., & Ito, S. (2002). Postprandial hypotension in elderly subjects: spectral analysis of heart rate variability and electrogastrograms. Journal of Gastroenterology, 37 (2), 87-93. https://doi.org/10.1007/s005350200001
  14. Kuiper, H. M., Jansen, R. W., Peeters, T L., & Hoefnagels, W. H. (1991). The influence of food temperature on postprandial blood pressure reduction and its relation to substance P in healthy elderly subjects. Journal of the American Geriatrics Society, 39, 181-184. https://doi.org/10.1111/j.1532-5415.1991.tb01623.x
  15. Luciano, G. L., Brennan, M. J., & Rothberg, M. B. (2010). Postprandial hypotension. The American Journal of Medicine, 123 (3), 281.e1-281.e6. https://doi.org/10.1016/j.amjmed.2009.06.026
  16. Mancia, G., & Grassi, G. (2008). The new European society of hypertension/European society of cardiology guidelines. Therapeutic Advances in Cardiovascular Disease, 2 (1), 5-12. https://doi.org/10.1177/1753944707087409
  17. Masuda, Y., & Kawamura, A. (2003). Role of the autonomic nervous system in postprandial hypotension in elderly persons. Journal of Cardiovascular Pharmacology, 42 , S23-26. https://doi.org/10.1097/00005344-200312001-00007
  18. O'Donovan, D., Feinle, C., Tonkin, A., Horowitz, M., & Jones, K. L. (2002). Postprandial hypotension in response to duodenal glucose delivery in healthy older subjects. The Journal of Physiology, 540 (2), 673-679. https://doi.org/10.1113/jphysiol.2001.013442
  19. O'Mara, G., & Lyons, D. (2002). Postprandial hypotension. Clinics in Geriatric Medicine, 18 (2), 307-321. https://doi.org/10.1016/S0749-0690(02)00012-5
  20. Oberman, A. S., Gagnon, M. M., Kiely, D. K., Nelson, J. C., & Lipsitz, L. A. (2000). Autonomic and neurohumoral control of postprandial blood pressure in healthy aging. The Journals of Gerontology. Series A, Biological Science and Medical Science, 55 (8), M477-M483. https://doi.org/10.1093/gerona/55.8.M477
  21. Prakash, E. S., Madanmohan, Sethuraman, K. R., & Narayan, S. K. (2005). Cardiovascular autonomic regulation in subjects with normal blood pressure, high-normal blood pressure and recent-onset hypertension. Clinical and Experimental Pharmacology and Physiology, 32 , 488-494. https://doi.org/10.1111/j.1440-1681.2005.04218.x
  22. Pumprla, J., Howorka, K., Groves, D., Chester, M., & Nolan, J. (2002). Functional assessment of heart rate variability: Physiological basis and practical applications. International Journal of Cardiology, 84 , 1-14. https://doi.org/10.1016/S0167-5273(02)00057-8
  23. Ryan, S. M., Goldberger, A. L., Ruthazer, R., Mietus, J., & Lipsitz, L. A. (1992). Spectral analysis of heart rate dynamics in elderly persons with postprandial hypotension. The American Journal of Cardiology, 15 (3), 201-205.
  24. Son, J. T., & Lee, E. (2009). Prevalence and risk factors of postprandial hypotension in Korean elderly people. Journal of Korean Academy of Nursing, 39 , 198-206. doi:10.4040/jkan.2009.39.2.198
  25. Sucharita, S., Bantwal, G., Idiculla, J., Ayyar, V., & Vaz, M. (2011). Autonomic nervous system function in type 2 diabetes using conventional clinical autonomic tests, heart rate and blood pressure variability measures. Indian Journal of Endocrinology and Metabolism, 15 (3), 198-203. https://doi.org/10.4103/2230-8210.83406
  26. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. (1996). Heart rate variability; standards of measurement, physiological interpretation and clinical use. European Heart Journal, 17 , 354-381. https://doi.org/10.1093/oxfordjournals.eurheartj.a014868
  27. Thayer, J. F., Yamamoto, S. S., & Brosschot, J. F. (2010). The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. International Journal of Cardiology, 141 , 122-131. https://doi.org/10.1016/j.ijcard.2009.09.543
  28. Vloet, L. C., Pel-Little, R. E., Jansen, P. A., & Jansen, R. W. (2005). High prevalence of postprandial and orthostatic hypotension among geriatric patients admitted to Dutch hospitals. The Journals of Gerontology. Series A, Biological Science and Medical Science, 60 (10), 1271-1277. https://doi.org/10.1093/gerona/60.10.1271
  29. Vloet, L. C., Smits, R., & Jansen, R. W. (2003). The effect of meals at different mealtimes on blood pressure and symptoms in geriatric patients with postprandial hypotension. The Journals of Gerontology. Series A, Biological Science and Medical Science, 58 (11), 1031-1035. https://doi.org/10.1093/gerona/58.11.M1031
  30. Ye, S. (1998). A study on the HRV of patients with observative sleep apnea. Unpublished master's thesis, Pusan National University, Busan.