Among elderly persons with limitations in activities of daily living, higher diastolic blood pressure (>80 mm Hg) was inversely associated with incident cardiovascular events (HR 0.49; 95% CI 0.25-0.94).
Cohort (n=3,547)
Does limitation in activities of daily living modify the association of systolic and diastolic blood pressure with incident cardiovascular events and death in elderly persons?
In elderly patients with functional limitations, lower diastolic blood pressure is associated with higher cardiovascular risk and mortality, suggesting functional status should inform hypertension management.
Effect estimate: HR 0.49 (95% CI 0.25-0.94)
Whether limitation in the ability to perform activities of daily living (ADL) or gait speed can identify elders in whom the association of systolic and diastolic blood pressure (DBP) with cardiovascular events (CVDs) and death differs is unclear. We evaluated whether limitation in ADL or gait speed modifies the association of systolic blood pressure or DBP with incident CVD (n=2358) and death (n=3547) in the Cardiovascular Health Study. Mean age was 78±5 and 21% reported limitation in ≥1 ADL. There were 778 CVD and 1289 deaths over 9 years. Among persons without and those with ADL limitation, systolic blood pressure was associated with incident CVD: hazard ratio HR (per 10-mm Hg increase) 1.08 (95% confidence interval, 1.03, 1.13) and 1.06 (0.97, 1.17), respectively. ADL modified the association of DBP with incident CVD. Among those without ADL limitation, DBP was weakly associated with incident CVD, HR 1.04 (0.79, 1.37) for DBP >80, compared with 80, compared with DBP ≤65. Among people with ADL limitation, a DBP of 66 to 80 had the lowest risk of death, HR 0.72 (0.57, 0.91), compared with a DBP of ≤65. Associations did not vary by 15-feet walking speed. ADL can identify elders in whom diastolic hypotension is associated with higher cardiovascular risk and death. Functional status, rather than chronologic age alone, should inform design of hypertension trials in elders.
Peralta et al. (Tue,) conducted a cohort in Elderly persons at risk for cardiovascular events and death (n=3,547). Diastolic blood pressure >80 mm Hg (in patients with ADL limitation) vs. Diastolic blood pressure ≤65 mm Hg was evaluated on Incident cardiovascular events (HR 0.49, 95% CI 0.25-0.94). Among elderly persons with limitations in activities of daily living, higher diastolic blood pressure (>80 mm Hg) was inversely associated with incident cardiovascular events (HR 0.49; 95% CI 0.25-0.94).