RT Journal
A1 Odden MC, Peralta CA, Haan MN, Covinsky KE
T1 Rethinking the association of high blood pressure with mortality in elderly adults: The impact of frailty
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2012
FD August 13
VO 172
IS 15
SP 1162
OP 1168
DO 10.1001/archinternmed.2012.2555
UL http://dx.doi.org/10.1001/archinternmed.2012.2555
AB 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.