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J Am Geriatr Soc. 2016 May;64(5):1015-23. doi: 10.1111/jgs.14084.

Gait Speed as a Guide for Blood Pressure Targets in Older Adults: A Modeling Study.

Author information

1
School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon.
2
College of Physicians and Surgeons, Columbia University, New York, New York.
3
Department of Medicine, University of California at San Francisco, San Francisco, California.
4
Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.

Abstract

OBJECTIVES:

To evaluate the potential for gait speed to inform decisions regarding optimal systolic blood pressure targets in older adults.

DESIGN:

Forecasting study from 2014 to 2023 using the Cardiovascular Disease Policy Model, a Markov model.

SETTING:

National Health and Nutrition Examination Survey.

PARTICIPANTS:

U.S. adults aged 60-94 stratified into fast walking, slow walking, and poor functioning (noncompleters) based on measured gait speed.

MEASUREMENTS:

Lowering SBP to a target of 140 or 150 mmHg was modeled in persons with (secondary prevention) and without (primary prevention) a history of coronary heart disease or stroke. Based on clinical trials and observational studies, it was projected that slow-walking and poor-functioning participants would have greater noncardiovascular mortality. Myocardial infarctions (MIs), strokes, deaths, cost, and disability-adjusted life years (DALYs) were measured.

RESULTS:

Regardless of gait speed, it was projected that secondary prevention to a systolic blood pressure (SBP) of 140 mmHg would prevent more events and save more money than secondary prevention to 150 mmHg. Similarly, primary prevention to 140 mmHg in fast-walking adults was projected to prevent events and save money. In slow-walking adults, primary prevention to 150 mmHg was projected to prevent MIs and strokes and save DALYs but was cost saving only in men; intensification to 140 mmHg is of uncertain benefit in slow-walking individuals. Primary prevention in poor-functioning adults to a target of 140 or 150 mmHg SBP is projected to decrease DALYs.

CONCLUSION:

The most cost-effective SBP target varies according to history of cardiovascular disease and gait speed in persons aged 60-94. These projections highlight the need for better estimates of the benefits and harms of antihypertensive medications in a diverse group of older adults, because the net benefit is sensitive to the characteristics of the population treated.

KEYWORDS:

Markov model; blood pressure; cost-benefit analysis; frailty; gait speed

PMID:
27225357
PMCID:
PMC5030071
DOI:
10.1111/jgs.14084
[Indexed for MEDLINE]
Free PMC Article

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