Prevalência de hipotensão ortostática e fatores associados no estudo longitudinal de saúde do adulto (ELSA-Brasil)

• Ano de defesa: 2018
• Autor(a) principal: Velten, Ana Paula Costa
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal do Espírito Santo; BR; Doutorado em Saúde Coletiva; Centro de Ciências da Saúde; UFES; Programa de Pós-Graduação em Saúde Coletiva
• Palavras-chave em Português: Hipotensão Ortostática; Prevalência; Associação; Fatores de risco; Doenças Cardiovasculares; Fatores de Risco; Epidemiologia; Saúde Coletiva; 614
• Link de acesso: http://repositorio.ufes.br/handle/10/10093

Orthostatic hypotension (OH) is a sustained reduction in blood pressure when the individual stands up from lying down. OH occurs as consequence of failure in compensatory mechanisms of reduced venous return. In population studies, OH has been associated with cardiovascular comorbidities such as coronary artery disease, atrial fibrillation, hypertension, heart failure, stroke, arterial stiffness and chronic kidney disease. Besides the risk factors for OH have been neglected in clinical practice, few epidemiological studies have dedicated to this subject. Moreover, studies in the Brazilian population are a missing. This thesis sought to estimate the prevalence of OH and its associated factors among participants of the Brazilian cohort "Longitudinal Study of Adult Health" (ELSA-Brazil). Data collected at baseline were used for 14,833 participants (both sexes, 35-74 years) who had complete data of postural maneuver. The postural maneuver was performed after 20 minutes rest in the supine position by active adoption of stand up posture. Blood pressure (BP) was measured at both supine and at 2, 3 and 5 minutes of orthostasis. OH was defined as a fall ≥20 mmHg in systolic BP and / or a fall ≥10 mmHg in diastolic BP at 3 minutes of orthostasis. The distribution of BP variation after the postural maneuver was determined in a subsample (N = 8,011) after exclusion of participants with cardiovascular morbidity and diabetes. Associated factors were determined by a cross sectional study. The covariates analyzed were gender, age range, race/skin color, schooling, nutritional status, waist circumference, changes in brachial ankle index, pulse wave velocity, heart disease, acute myocardial infarction (AMI)/revascularization, stroke, diabetes, hypertension, antihypertensive medication use, systolic and diastolic pressure, cholesterol, triglycerides, Chagas serology, presence of symptoms and variation of heart rate. The total prevalence of OH was 2.0% (95% CI: 1.8-2.3) and similar between sexes, with increasing frequency with age (1.2% at age <45 years and 3.4% at age > 65 years). When pressure drop in any time measured was used as criterion, the prevalence of OH increased to 4.3% (95% CI: 4.0-4.7). Symptoms as dizziness, visual changes and nausea were self-reported in 19.7% (95% CI: 15.6-24.6) of the participants with OH and only in 1.4% (95% CI: 1.2 -1.6) of the participants without HO. The -2 Z-scores of the pressure variations before and after the postural maneuver in the sub-sample were -14.1 mmHg in the systolic BP and -5.4 mmHg in the diastolic BP. OH was significantly associated with largest age group, OR: 1.83 (95% CI: 1.14-2.95); changes in brachial ankle index, OR: 2.8 (95% CI: 1.13-6.88), AMI/ revascularization, OR: 1.70 (95% CI: 1.01-2.87); self-reported heart disease, OR: 3.03 (95% CI: 1.71-5.36); increased systolic BP, OR: 1.012 (95% CI: 1.006-1.019); positive Chagas disease serology, OR: 2.29 (95% IC: 1.23-4.27) and self-reported symptoms in postural change, OR: 20.81 (95% CI: 14.81-29.24). The prevalence of OH varied substantially depending on the moment of pressure measurement. The current cutoff points adopted may underestimate the actual occurrence of OH in the population. The presence of OH could be very useful as an alert for potential cardiovascular impairment, and therefore a tool for screening and prevention.