ABC | Volume 114, Nº6, June 2020

Original Article Prevalence of Orthostatic Hypotension and the Distribution of Pressure Variation in the Longitudinal Study of Adult Health Ana Paula Costa Velten, 1 Isabela Bensenor, 2 Paulo Lotufo, 2 José Geraldo Mill 1 Universidade Federal do São Mateus, 1 Vitória, ES - Brazil Universidade de São Paulo, 2 São Paulo, SP – Brazil Mailing Address: Ana Paula Costa Velten • Universidade Federal do Espirito Santo - Rodovia Governador Mário Covas, Km 60 - Bairro Litorâneo. CEP 29932-540, São Mateus, ES - Brazil E-mail: paulinhavelten@hotmail.com Manuscript received November 14, 2018, revised manuscript May 28, 2019, accepted June 23, 2019 DOI: https://doi.org/10.36660/abc.20180354 Abstract Background: Orthostatic hypotension (OH) has been neglected in clinical practice, and there are no studies on its prevalence in the Brazilian population. Objective: To determine the prevalence of OH and blood pressure (BP) changes after the postural change maneuver in participants of the Longitudinal Study of Adult Health. Methods: In this descriptive study of baseline data (N = 14,833 adults, ages 35 – 74 years), participants remained lying down for 20 minutes and subsequently stood up actively. BP measurements were taken while the participants were supine and at 2, 3, and 5 minutes after standing. OH was defined as a reduction of ≥ 20 mmHg in systolic BP and/or a reduction of ≥ 10 mmHg in diastolic BP at 3 minutes, and its prevalence was determined with a 95% confidence interval (CI). The distribution of BP variation after the postural change maneuver was determined in a subsample (N = 8,011) obtained by removing patients with cardiovascular morbidity and/or diabetes. Results: The prevalence of OH was 2.0% (95% CI: 1.8 – 2.3), increasing with age. If the criterion applied were a BP reduction during any measurement, the prevalence would increase to 4.3% (95% CI: 4.0 – 4.7). Symptoms (dizziness, scotoma, nausea, etc.) were reported by 19.7% of participants (95% CI: 15.6 – 24.6) with OH and 1.4% (95% CI: 1.2 – 1.6) of participants without OH. The −2 Z-scores of BP variation before and after the postural change maneuver in the subsample were −14.1 mmHg for systolic BP and −5.4 mmHg for diastolic BP. Conclusion: Prevalence of OH varies depending on when BP is measured. Current cutoff points may underestimate the actual occurrence of OH in the population. (Arq Bras Cardiol. 2020; 114(6):1040-1048) Keywords: Hypotension, Orthostatic/epidemiology; Prevalence; Coronary Artery Disease; Blood Pressure; Standing Position. divergence in the methodology for measuring blood pressure (BP) and even in the criteria for definition. Most of the studies have been carried out in specific populations, such as elderly patients; patients with diabetes, hypertension, or Alzheimer’s disease; or hospitalized or institutionalized individuals. 8 Even though it is a simple and inexpensive assessment, BP measurement with the postural change maneuver is not commonly used in clinical practice, and few epidemiological studies have evaluated the measurement, its associated factors, and its implications for general health status. The prevalence of OH found in populations that most approximate the general population differs greatly according to age, varying, mostly, from around 5% (45 to 64 years of age) to 30% in studies including only elderly individuals (> 65 years). 4,9 Practically all of the studies carried out have been in populations from North America, 5,10 Europe, 1,2 and Asia, 11 and none of them have applied the criteria of a reduction of 30 mmHg in SBP for patients with hypertension. This study ’s objectives were to determine the prevalence of OH in a Brazilian population, to verify its association with symptoms, and to describe the distribution of BP changes following the postural change maneuver. Introduction Longitudinal studies have shown that orthostatic hypotension (OH) is a predictor of increased risk of overall mortality and other health issues, such as coronary artery disease, cerebrovascular disease, atrial fibrillation, heart failure, and new cases of hypertension. 1-5 Current guidelines define OH as a sustained reduction of 20 mmHg in systolic blood pressure (SBP) and/or 10 mmHg in diastolic blood pressure (DBP) within 3 minutes after standing . 6 The same consensus statement also suggests a reduction of 30 mmHg in SBP in individuals with hypertension as a more adequate criterion. Since the first definition of OH, 7 the number of studies investigating the prevalence of this finding in the general population has been low, and there has been great 1040