고혈압노인의 식사시간 별 식후저혈압 발생실태 = Prevalence of Postprandial Hypotension in the Elderly People with Hypertension according to Mealtimes

다국어 초록 (Multilingual Abstract)

The purposes of this study were to identify the degree of postprandial blood pressure reduction and the prevalence of postprandial hypotension by 3 different mealtimes of elderly people diagnosed with hypertension in nursing homes. After the informed and written consent, a total of 187 elderly people were recruited in the study. Systolic BP, diastolic BP were measured with ambulatory BP monitor every 15 minutes interval from 30 minutes before a meal until 120 minutes after each meal.
The maximum SBP reduction was significantly bigger at breakfast than lunchtime or dinnertime.
Among 187 elders, 137(73.4%) showed PPH at breakfast, 103(54.2%) at lunchtime, and 96(50.2%) at dinnertime. The most prevalent time point of PPH was 90 minutes after the initiation of a meal in all of 3 mealtimes. Among 8 measurement times, the prevalence of PPH was significantly higher in breakfast (3.0±2.7 times) than both lunchtime (2.1±2.5 times) and dinnertime (1.9±2.4 times).
Although the occurrence of PPH by every mealtime should be taken into account in caring for the elderly, postprandial BP measurements need more attention after breakfast. Nurses should develop appropriate nursing interventions that can prevent postprandial blood pressure reduction in elderly people with hypertension.

국문 초록 (Abstract)

본 연구의 목적은 고혈압노인의 식사시간 별 혈압변화와 식후저혈압(PPH: Postprandial hypotension) 발생을 파악하기 위해 아침, 점심, 저녁 세 끼 식사 전후의 혈압을 측정하였다. 노인 복지시설에 거주하는 고혈압 노인 187명으로부터 서면동의를 받은 후 시행되었다. 혈압측정 도구는 휴대용 혈압모니터(ABPM)를 사용하여 아침, 점심, 저녁의 식전 30분부터 식후 2시간까지 15분 간격으로 측정하였다. 수집된 자료는 SPSS Win 14.0 program으로 빈도와 백분율, 평균과 표준편차, ANOVA와 Scheffé 사후검정을 이용하여 분석하였으며, 연구결과는 다음과 같다. • 수축기혈압과 이완기혈압의 하강 정도는 아침 식후가 점심이나 저녁 식후 보다 유의하게 더 많았다. • PPH 발생률은 아침 식후에는 73.4%, 점심 식후에는 54.2%, 저녁에는 50.2%이었다.
• PPH가 가장 많이 발생한 시점은 아침과 점심 저녁 모두 식사 시작 후 90분이었다. • 식후 혈압을 8회 측정한 것을 기준했을 때, 평균 PPH 발생 횟수는 아침 식후가 평균 3.0±2.7회로 점심 평균 2.1±2.5회와 저녁 평균 1.9±2.4회 보다 더 많았다. 고혈압노인의 간호에서는 점심이나 저녁 식사에서보다는 아침식사 후에 PPH 발생이 더 많다는 점을 고려하여야 할 것이다. 또한 식사 시작 후 1시간에서 2시간 동안은 PPH로 인한 건강문제가 발생하지 않도록 주의관찰과 간호관리가 이루어져야 한다. 아울러 고혈압노인의 PPH를 조절할 수 있는 간호중재를 개발하기 위한 추후연구가 활성화되어야 한다.

참고문헌 (Reference)

1 유수정, "재가 노인의 식사후 저혈압 발생에 관한 연구" 9 (9): 434-444, 2002

2 손정태, "노인의 식사 후 저혈압의 발생실태와 위험요인" 한국간호과학회 39 (39): 198-206, 2009

3 Masuo, K., "Tuck, M. L" 9 (9): 536-544, 1996

4 Vloet, L. C., "The influence of low-, normal-, and high-carbohydrate meals on blood pressure in elderly patients with postprandial hypotension" 55 (55): M535-M540, 2001

5 Kuipers, H. M., "The influence of food temperature on postprandial blood pressure reduction and its relation to substance-p in healthy elderly subjects" 39 (39): 181-184, 1991

6 Vloet, L. C., "The effect of meals at different mealtimes on blood pressure and symptoms in geriatric patients with postprandial hypotension" 58 (58): 1031-1035, 2003

7 Fisher, A. A., "The effect of meals at different meal times on blood pressure and symptoms in geriatric patients with postprandial hypotension" 60 (60): 184-186, 2005

8 Sidery, M. B., "The effect of meal size on the cardiovascular responses to food ingestion" 71 (71): 835-848, 1994

9 Visvanathan, R., "The effect of drinks made from simple sugars on blood pressure in healthy older people" 93 (93): 575-579, 2005

10 Smith N. L., "The association between time since last meal and blood pressure in older adults: The cardiovascular health study" 51 (51): 824-828, 2003

11 Cohen, I., "Predictors of medication use, compliance and symptoms of hypotension in a community-based sample of elderly men and women" 23 (23): 423-432, 1998

12 Le Couteur, D. G. L., "Postprandial systolic blood pressure responses older people in residential care: Association with risk of falling" 49 (49): 260-264, 2003

13 Kawaguchi, R., "Postprandial hypotensionin elderly subjects: spectral analysis of heart rate variability and electrogastrograms" 37 (37): 87-93, 2002

14 Kohara, K., "Postprandial hypotension: evaluation by ambulatory blood pressure monitoring" 11 (11): 1358-1363, 1998

15 Jansen, R. W., "Postprandial hypotension: Epidemiology, pathophysiology, and clinical management" 122 (122): 286-295, 1995

16 Gentilcore, D., "Postprandial hypotension- novel insights into pathophysiology and therapeutic implications" 4 (4): 161-171, 2006

17 Fisher, A. A., "Postprandial hypotension predicts all-cause mortality in older, low-level care residents" 53 (53): 1313-1320, 2005

18 Kohara, K., "Postprandial hypotension is associated with asymptomatic cerebrovascular damage in essential hypertensive patients" 33 (33): 565-568, 1999

19 Lubart, E., "Postprandial hypotension in long-term care elderly patients on enteral feeding" 54 (54): 1377-1381, 2006

20 Jansen, R. W., "Postprandial hypotension in elderly patients with unexplained syncope" 155 (155): 945-952, 1995

21 Lilley, M. D., "Postprandial blood pressure changes in the elderly" 23 (23): 17-25, 1997

22 Morley, J. E., "Postprandial Hypotension -The ultimate Big Mac Attack" 56 (56): M741-M743, 2001

23 Luciano, G. L., "Postprandial Hypotension" 123 (123): 281-281, 2010

24 Villavicencio-Chavez, C., "Orthostatic and Postprandial hypotension in elderly patients with chronic disease and disability: prevalence and related factors" 44 (44): 12-18, 2009

25 Kario, K., "Morning Surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives; A prospective study" 107 (107): 1401-1406, 2003

26 Jansen, R. W., "Intraindividual reproducibility of postprandial and orthostatic blood pressure changes in older nursing-home patients: relationship with chronic use of cardiovascular medications" 44 (44): 383-389, 1996

27 National Hypertension Center, "Incidence of hypertension. Retrived Feb 4, 2009"

28 Vloet, L. C. M., "High prevalence of postprandial and orthostatic hypotension among geriatric patients admitted to dutch hospitals" 60A (60A): 1271-1277, 2005

29 Vaitkevicius, P. V., "Frequency and importance of postprandial blood pressure reduction in elderly nursing-home patients" 115 (115): 865-870, 1991

30 Jones, K. L., "Effects of drink volume and glucose load on gastric emptying and postprandial blood pressure in healthy older subjects" 289 (289): G240-G248, 2005

31 Pugh K. G., "Clinical Implications of Physiological changes in the Aging Heart" 18 (18): 263-276, 2001

32 Aronow, W. S., "Association of postprandial hypotension with incidence of falls, syncope, coronary events, stroke, and total mortality at 29-month follow-up in 499 older nursing home residents" 45 (45): 1051-1053, 1997

33 Puisieux, F, "Ambulatory blood pressure monitoring and postprandial hypotension in elderly persons with falls or syncopes" 55 (55): M535-M540, 2000

34 Grodzicki, T., "Ambulatory blood pressure monitoring and postprandial hypotension in elderly patients with isolated systolic hypertension. Systolic hypertension in Europe (SYST-EUR) Trial investigators" 12 (12): 161-165, 1998