TitleGait Speed as a Guide for Blood Pressure Targets in Older Adults: A Modeling Study.
Publication TypeJournal Article
Year of Publication2016
AuthorsOdden, MC, Moran, AE, Coxson, PG, Peralta, CA, Goldman, L, Bibbins-Domingo, K
JournalJ Am Geriatr Soc
Volume64
Issue5
Pagination1015-23
Date Published2016 May
ISSN1532-5415
KeywordsAged, Aged, 80 and over, Blood Pressure Determination, Female, Geriatric Assessment, Humans, Hypertension, Male, Markov Chains, Middle Aged, Nutrition Surveys, Primary Prevention, Quality-Adjusted Life Years, Risk Assessment, Secondary Prevention, United States, Walking Speed
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.

DOI10.1111/jgs.14084
Alternate JournalJ Am Geriatr Soc
PubMed ID27225357
PubMed Central IDPMC5030071
Grant ListU54 NS081760 / NS / NINDS NIH HHS / United States
K01 AG039387 / AG / NIA NIH HHS / United States
R01 HL107475 / HL / NHLBI NIH HHS / United States
K24 DK103992 / DK / NIDDK NIH HHS / United States
R01 AG046206 / AG / NIA NIH HHS / United States