Prevalence of Orthostatic Hypotension and the Distribution of Pressure Variation in the Longitudinal Study of Adult Health

Velten, Ana Paula Costa; Bensenor, Isabela; Lotufo, Paulo; Mill, José Geraldo

doi:10.36660/abc.20180354

Acessibilidade / Reportar erro

Brasil

Arquivos Brasileiros de Cardiologia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Arq. Bras. Cardiol. 114 (6) • June 2020 • https://doi.org/10.36660/abc.20180354 copy

Prevalence of Orthostatic Hypotension and the Distribution of Pressure Variation in the Longitudinal Study of Adult Health

Authorship SCIMAGO INSTITUTIONS RANKINGS

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)

Hypotension, Orthostatic/epidemiology; Prevalence; Coronary Artery Disease; Blood Pressure; Standing Position

Variables		Orthostatic hypotension

		Present	Total	Prevalence (95% CI*)
Study population (n = 14,833)

Sex	Male	135	6,796	2.0 (1.7 - 2.4)
Sex	Female	165	8,037	2.0 (1.8 - 2.4)
Age range	35 to 44 years	39	3,298	1.2 (0.9 - 1.6)
	45 to 54 years	93	5,825	1.6 (1.3 – 2.0)
	55 to 64 years	116	4,157	2.8 (2.3 - 3.3)
	65 to 74 years	52	1,553	3.3 (2.6 - 4.3)
Color/race	Black	59	2,342	2.5 (2.0 - 3.2)
	Mixed	81	4,110	1.9 (1.6 - 2.4)
	White	139	7,679	1.8 (1.5 - 2.1)
	Yellow/Indigenous	13	525	2.5 (1.5 - 4.2)
Highest level of schooling completed	Primary	57	1,883	3.0 (2.3 - 3.9)
	Secondary	110	5,133	2.1 (1.8 - 2.6)
	Tertiary	133	7,817	1.7 (1.4 - 2.0)
Total		300	14,833	2.0 (1.8 – 2.2)

Subsample of the study population† (n = 8,011)

Sex	Male	56	3,289	1.7 (1.3 - 2.2)
Sex	Female	66	4,722	1.4 (1.1 - 1.8)
Age range	35 to 44 years	33	2,570	1.3 (0.9 - 1.8)
	45 to 54 years	50	3,388	1.5 (1.1 - 1.9)
	55 to 64 years	30	1,688	1.8 (1.2 - 2.5)
	65 to 74 years	9	365	2.5 (1.3 - 4.6)
Color/race	Black	16	1,223	1.3 (0.8 - 2.1)
	Mixed	39	2,219	1.8 (1.3 - 2.4)
	White	63	4,181	1.5 (1.2 - 1.9)
	Yellow/Indigenous	3	284	1.1 (0.4 - 3.1)
Highest level of schooling completed	Primary	15	645	2.3(1.4 - 3.8)
	Secondary	39	2,643	1.5 (1.1 - 2.0)
	Tertiary	68	4,723	1.4 (1.1 - 1.9)
Total		122	8,011	1.5 (1.3 - 1.8)

Age range by sex		Δ SBP (mmHg)				Δ DBP (mmHg)

		Average (µ)	Standard deviation (σ)	µ-2σ	µ-3σ	Average (µ)	Standard deviation (σ)	µ-2σ	µ-3σ
Study population (n = 14,833)

Total	Total	3.62	9.72	−15.81	−25.53	7.05	6.56	−6.07	−12.64
	Male	3.80	9.51	−15.21	−24.72	7.33	6.63	−5.93	−12.56
	Female	3.47	9.89	−16.31	−26.20	6.81	6.50	−6.18	−12.67
35 to 44 years	Total	4.05	8.34	−12.63	−20.97	8.67	6.34	−4.00	−10.34
	Male	3.99	8.44	−12.89	−21.33	9.22	6.13	−3.05	−9.18
	Female	4.10	8.25	−12.40	−20.65	8.19	6.48	−4.76	−11.24
45 to 54 years	Total	3.59	9.06	−14.53	−23.59	7.29	6.51	−5.74	−12.26
	Male	4.04	8.74	−13.44	−22.18	7.81	6.69	−5.57	−12.26
	Female	3.21	9.30	−15.39	−24.69	6.85	6.33	−5.82	−12.15
55 to 64 years	Total	3.23	10.70	−18.16	−28.86	6.15	6.44	−6.74	−13.18
	Male	3.27	10.56	−17.85	−28.40	6.22	6.38	−6.55	−12.94
	Female	3.20	10.81	−18.41	−29.22	6.09	6.49	−6.89	−13.38
65 to 74 years	Total	3.91	11.81	−19.70	−31.51	5.13	6.64	−8.15	−14.79
	Male	3.86	11.21	−18.57	−29.78	4.55	6.57	−8.58	−15.15
	Female	3.96	12.38	−20.79	−33.17	5.70	6.67	−7.63	−14.30

*Subsample of the study population (n = 8,011)**

Total	Total	3.77	8.93	−14.09	−23.03	7.48	6.43	−5.39	−14.96
	Male	3.76	8.83	−13.90	−22.73	7.89	6.40	−4.90	−15.79
	Female	3.78	9.01	−14.23	−23.24	7.19	6.44	−5.70	−14.38
35 to 44 years	Total	4.17	8.35	−12.53	−20.88	8.70	6.30	−3.91	−17.39
	Male	3.99	8.53	−13.08	−21.61	9.25	6.16	−3.07	−18.49
	Female	4.32	8.21	−12.10	−20.31	8.27	6.38	−4.49	−16.54
45 to 54 years	Total	3.59	8.67	−13.76	−22.43	7.31	6.35	−5.39	−14.62
	Male	3.92	8.33	−12.74	−21.07	7.83	6.28	−4.74	−15.66
	Female	3.36	8.89	−14.43	−23.32	6.95	6.37	−5.79	−13.90
55 to 64 years	Total	3.50	9.80	−16.11	−25.91	6.37	6.38	−6.38	−12.74
	Male	3.00	9.75	−16.49	−26.23	6.41	6.41	−6.40	−12.82
	Female	3.79	9.83	−15.87	−25.70	6.34	6.36	−6.38	−12.69
65 to 74 years	Total	3.89	10.80	−17.71	−28.52	5.64	6.88	−8.13	−11.27
	Male	3.65	10.92	−18.19	−29.11	4.80	6.62	−8.43	−9.61
	Female	4.08	10.73	−17.39	−28.12	6.29	7.04	−7.79	−12.57

Sociedade Brasileira de Cardiologia - SBC Avenida Marechal Câmara, 160, sala: 330, Centro, CEP: 20020-907, (21) 3478-2700 - Rio de Janeiro - RJ - Brazil, Fax: +55 21 3478-2770 - São Paulo - SP - Brazil
E-mail: revista@cardiol.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] 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