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Arch Intern Med. 2012 Aug 13;172(15):1162-8. doi: 10.1001/archinternmed.2012.2555.

Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty.

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  • 1College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA. Michelle.Odden@oregonstate.edu

Abstract

BACKGROUND:

The association of hypertension and mortality is attenuated in elderly adults. Walking speed, as a measure of frailty, may identify which elderly adults are most at risk for the adverse effects of hypertension. We hypothesized that elevated blood pressure (BP) would be associated with a greater risk of mortality in faster-, but not slower-, walking older adults.

METHODS:

Participants included 2340 persons 65 years and older in the National Health and Nutrition Examination Survey, 1999-2000 and 2001-2002. Mortality data were linked to death certificates in the National Death Index. Walking speed was measured over a 20-ft (6 m) walk and classified as faster (≥ 0.8 m/s [n = 1307]), slower (n = 790), or incomplete (n = 243). Potential confounders included age, sex, race, survey year, lifestyle and physiologic variables, health conditions, and antihypertensive medication use.

RESULTS:

Among the participants, there were 589 deaths through December 31, 2006. The association between BP and mortality varied by walking speed. Among faster walkers, those with elevated systolic BP (≥ 140 mm Hg) had a greater adjusted risk of mortality compared with those without (hazard ratio [HR], 1.35; 95% CI, 1.03-1.77). Among slower walkers, neither elevated systolic nor diastolic BP (≥ 90 mm Hg) was associated with mortality. In participants who did not complete the walk test, elevated BP was strongly and independently associated with a lower risk of death: HR, 0.38; 95% CI, 0.23-0.62 (systolic); and HR, 0.10; 95% CI, 0.01-0.81 (diastolic).

CONCLUSIONS:

Walking speed could be a simple measure to identify elderly adults who are most at risk for adverse outcomes related to high BP.

Comment in

PMID:
22801930
[PubMed - indexed for MEDLINE]
PMCID:
PMC3537835
Free PMC Article

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