Prevalence, influencing factors, and preprandial blood pressure management target for postprandial hypotension in older adults with hypertension in long-term care facilities.

This study identified the prevalence, influencing factors, and appropriate preprandial blood pressure (BP) management targets for postprandial hypotension (PPH) in older adults with hypertension in long-term care facilities (LTCFs). A multicenter cross-sectional study involving 25 LTCFs was conducted from June 2022 to August 2024. Trained researchers used validated automatic BP monitors to measure participants' BPs 30 min and immediately before breakfast and at 0-, 30-, 60-, 90-, and 120-min postprandially. Statistical methods included logistic regression modeling and restricted cubic splines. PPH affected 56.7% of 608 eligible participants. Preprandial systolic BP (odds ratio [OR]: 1.056, 95% confidence interval [CI]: 1.040-1.071) and metformin use (OR: 0.498, 95% CI: 0.267-0.926) were related to its occurrence. In sensitivity and subgroup analyses, age (OR: 1.034 ~ 1.038), body mass index (OR: 0.879 ~ 0.917), preprandial diastolic BP (OR: 0.899 ~ 1.085), the Chinese version of FRAIL-NH scores (OR: 1.163, 95% CI: 1.039-1.303), and using diuretics (OR: 1.971, 95% CI: 1.059-3.668) and calcium channel blockers (OR: 0.490, 95% CI: 0.267-0.897) were associated with PPH. The dose-response relationship between high preprandial BP and the PPH risk exhibited a monotonous increase. However, different inflection points were acquired, ranging from 133.8 ~ 142.9 mmHg for systolic BP and 72.6 ~ 78.8 mmHg for diastolic BP, according to postprandial BP decline patterns, existing frailty (yes or no) or cognitive dysfunction (yes or no). PPH is prevalent in older adults with hypertension in LTCFs and is related to modifiable factors. Personalized preprandial BP management may reduce its risk in these individuals. Further longitudinal and interventional studies are warranted to expand these results.