title: Effects of Age and Functional Status on the Relationship of Systolic Blood Pressure With Mortality in Mid and Late Life: The ARIC Study.
abstract: Impaired functional status attenuates the relationship of systolic blood pressure (SBP) with mortality in older adults but has not been studied in middle-aged populations.
  
  
  
  Among 10,264 stroke-free Atherosclerosis Risk in Communities participants (mean age 62.8 [5.7] years; 6,349 [62%] younger [<65 years]; 5,148 [50%] men; 2,664 [26%] Black), function was defined as good function (GF) for those self-reporting no difficulty performing functional tasks and basic or instrumental tasks of daily living; all others were defined as impaired function (IF). SBP categories were normal (<120 mmHg), prehypertension (120-139 mmHg), and hypertension (≥140 mmHg). Mortality risk associated with SBP was estimated using adjusted Cox proportional hazard models with a triple interaction between age, functional status, and SBP.
  
  
  
  Mean follow-up was 12.9 years with 2,863 (28%) deaths. Among younger participants, 3,017 (48%) had IF; 2,279 of 3,915 (58%) older participants had IF. Prehypertension (hazard ratio [HR] = 1.48 [1.03, 2.15] p = .04) and hypertension (HR = 1.97 [1.29, 3.03] p = .002) were associated with mortality in younger GF and older (≥65 years) GF participants (prehypertension HR = 1.21 [1.06, 1.37] p = .005; hypertension HR = 1.47 [1.36, 1.59] p < .001). Among IF participants, prehypertension was not associated with mortality in younger participants (HR = 0.99 [0.85, 1.15] p = .93) and was protective in older participants (HR = 0.87 [0.85, 0.90] p < .001). Hypertension was associated with mortality in younger IF participants (HR = 1.54 [1.30, 1.82] p < .001) but not in older IF participants (HR = 0.99 [0.87, 1.14] p = .93).
  
  
  
  Compared with younger and well-functioning persons, the additional contribution of blood pressure to mortality is much lower with older age and impaired function, particularly if both are present. Functional status and age could potentially inform optimal blood pressure targets.
authors.affiliation: Department of Medicine-Geriatrics and gwindham@umc.edu.
authors.forename: B Gwen
authors.initials: BG
authors.lastname: Windham
authors.affiliation: Center of Biostatistics, University of Mississippi Medical Center, Jackson.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Griswold
authors.affiliation: Center of Biostatistics, University of Mississippi Medical Center, Jackson.
authors.forename: Seth
authors.initials: S
authors.lastname: Lirette
authors.affiliation: Kucharska-Newton: Cardiovascular Disease Program, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
authors.forename: Anna
authors.initials: A
authors.lastname: Kucharska-Newton
authors.affiliation: Division of Epidemiology, The Ohio State University College of Public Health, Columbus.
authors.forename: Randi E
authors.initials: RE
authors.lastname: Foraker
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis.
authors.forename: Wayne
authors.initials: W
authors.lastname: Rosamond
authors.affiliation: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.affiliation: Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kritchevsky
authors.affiliation: Department of Medicine-Geriatrics and.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mosley
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D050197:Atherosclerosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors
keywords: Blood pressure; Functional status.; Middle aged; Mortality