title: Systolic and diastolic blood pressure, incident cardiovascular events, and death in elderly persons: the role of functional limitation in the Cardiovascular Health Study.
abstract: 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 <65 mm Hg. Among those with ADL limitation, DBP was inversely associated with CVD: HR 0.65 (0.44, 0.96) for DBP 66 to 80 mm Hg and HR 0.49 (0.25, 0.94) for DBP >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.
authors.affiliation: From the Department of Medicine, University of California, San Francisco (C.A.P.), Nephrology Division, San Francisco VA Medical Center, CA (C.A.P.); Kidney Research Institute (R.K.) and Cardiovascular Health Research Unit (B.M.P.), University of Washington, Seattle; Department of Epidemiology, University of Pittsburgh, PA (A.B.N.); College of Public Health and Human Sciences, Oregon State University, Corvallis (M.C.O.). carmenalicia.peralta@ucsf.edu.
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Peralta
authors.affiliation: From the Department of Medicine, University of California, San Francisco (C.A.P.), Nephrology Division, San Francisco VA Medical Center, CA (C.A.P.); Kidney Research Institute (R.K.) and Cardiovascular Health Research Unit (B.M.P.), University of Washington, Seattle; Department of Epidemiology, University of Pittsburgh, PA (A.B.N.); College of Public Health and Human Sciences, Oregon State University, Corvallis (M.C.O.).
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.affiliation: From the Department of Medicine, University of California, San Francisco (C.A.P.), Nephrology Division, San Francisco VA Medical Center, CA (C.A.P.); Kidney Research Institute (R.K.) and Cardiovascular Health Research Unit (B.M.P.), University of Washington, Seattle; Department of Epidemiology, University of Pittsburgh, PA (A.B.N.); College of Public Health and Human Sciences, Oregon State University, Corvallis (M.C.O.).
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.affiliation: From the Department of Medicine, University of California, San Francisco (C.A.P.), Nephrology Division, San Francisco VA Medical Center, CA (C.A.P.); Kidney Research Institute (R.K.) and Cardiovascular Health Research Unit (B.M.P.), University of Washington, Seattle; Department of Epidemiology, University of Pittsburgh, PA (A.B.N.); College of Public Health and Human Sciences, Oregon State University, Corvallis (M.C.O.).
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.affiliation: From the Department of Medicine, University of California, San Francisco (C.A.P.), Nephrology Division, San Francisco VA Medical Center, CA (C.A.P.); Kidney Research Institute (R.K.) and Cardiovascular Health Research Unit (B.M.P.), University of Washington, Seattle; Department of Epidemiology, University of Pittsburgh, PA (A.B.N.); College of Public Health and Human Sciences, Oregon State University, Corvallis (M.C.O.).
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Odden
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality; D003971:Diastole / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D012307:Risk Factors; D015996:Survival Rate; D013599:Systole / Q000502:physiology; D044465:White People
keywords: activities of daily living; aged; hypertension