ABC | Volume 114, Nº6, June 2020

Original Article Velten Orthostatic hypotension and pressure variation: ELSA Arq Bras Cardiol. 2020; 114(6):1040-1048 small decrease in prevalence was observed (from 2% to 1.5%), obviously owing to the fact that the cutoff point was shifted to the left. The suggestion of 30mmHg is justified in the guidelines 6 due to the higher initial BP in patients with hypertension. However, in patients with hypertension in the ELSA, fewer than half presented uncontrolled BP, posing a doubt as to how to proceed in this situation, given that the definition does not address it. We found no allusion to the prevalence of OH in patients with hypertension applying this criterion in other studies. Regarding the prevalence in other measurements, it stands out that there was an increase as time progressed, and many individuals presented OH in only one of the three pressure measurements. The simultaneous present during the three moments was only 0.6%, also showing a relation to aging, and it was 4.3% in any measurement. An associative analysis with the main factors related to OH found in the literature may indicate which moment(s) would be most appropriate for evaluating OH in this population. Regarding the presence of symptoms and the prevalence of OH during the three moments, the individuals who presented OH at 3 minutes were the ones who most reported symptoms. It is worth remembering that there is no information regarding the exact moment when the symptoms were reported, and the symptom may have been related or occurred immediately after standing or closer to the pressure measurement at 5 minutes. The presence of symptoms, especially dizziness and syncope, may have a great impact on the individuals’ health, given that it may affect their mobility and safety. It is necessary to use caution when extending the findings in our sample to the general population, as it is a professional cohort. However, the sample was large enough to allow for subgroup analysis, and a great part of the spectrumof diversity in age, race/ color, and level of schooling that exists in Brazil is represented in both sexes of the sample. Therefore, in the absence of population data, the data from the ELSA-Brazil currently constitute the best reference for the presence of OH in the Brazilian population. Conclusion The prevalence of OH in a sample of Brazilian civil servants was around 2%, considering the pressure measurements obtained at 3 minutes after standing. This prevalence was equal in both sexes, and age was the factor that most influenced prevalence. The pressure measurement at 3 minutes after standing is the one that best correlates with the presence of symptoms. Current cutoff points (−20 mmHg in SBP and −10 mmHg in DBP) may underestimate the real occurrence of OH in the population. Author contributions Conception and design of the research and Critical revision of the manuscript for intellectual content: Velten APC, Bensenor I, Lotufo P, Mill JG; Acquisition of data and obtaining financing: Bensenor I, Lotufo P, Mill JG; Analysis and interpretation of the data: Velten APC, Bensenor I, Mill JG; Statistical analysis: Velten APC; Writing of the manuscript: Velten APC, Mill JG. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding This study was funded by Ministério da Saúde and Ministérios da Ciência and Tecnologia. Study Association This article is part of the thesis of Doctoral submitted by Ana Paula Costa Velten from Universidade Federal do Espírito Santo. Ethics approval and consent to participate This study was approved by the National Research Ethics Commission (CONEP) under the protocol number CAAE 0016.1.198.000-06 . All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. 1. Fedorowski A, Stavenow L, Hedblad B, Berglund G, Nilsson PM, Melander O. Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals. Eur Heart J. 2010;31(1):85-91. 2. FedorowskiA,EngströmG,HedbladB,MelanderO.Orthostatichypotension predicts incidence of heart failure: the Malmö Preventive Project. Am J Hypertens. 2010;23(11):1209–15. 3. Fedorowski A, Hedblad B, Engström G, Gustav Smith J, Melander O. Orthostatic hypotension and long-term incidence of atrial fibrillation: the Malmö Preventive Project: J InternMed. 2010;268(4):383–9. 4. EigenbrodtML,RoseKM,CouperDJ,ArnettDK,SmithR,JonesD.Orthostatic hypotensionasariskfactorforstroke :theAtherosclerosisRisk inCommunities (ARIC) study, 1987-1996. Stroke. 2000;31(10):2307–13. 5. Rose KM, Holme I, Light KC, Sharrett AR, Tyroler HA, Heiss G. Association between the blood pressure response to a change in posture and the 6-year incidence of hypertension: prospective findings from the ARIC study. J Hum Hypertens. 2002;16(11):771–7. 6. Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, et al.Consensusstatementonthedefinitionoforthostatichypotension,neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res. 2011;21(2):69–72. 7. Kaufmann H. Consensus statement on the definition of orthostatic hypotension,pureautonomicfailureandmultiplesystematrophy.ClinAuton Res. 1996;6(2):125–6. 8. Fedorowski A, Melander O. Syndromes of orthostatic intolerance: a hidden danger. J InternMed. 2013;273(4):322–35. 9. Veronese N, Bolzetta F, De Rui M, Zambon S, Corti MC, Musacchio E, et al. Serum25-hydroxyvitaminD and orthostatic hypotension in old people: The Pro.V.A. study. Hypertension. 2014;64(3):481–6. References 1047