title: Gait Speed as a Guide for Blood Pressure Targets in Older Adults: A Modeling Study.
abstract: To evaluate the potential for gait speed to inform decisions regarding optimal systolic blood pressure targets in older adults.
  
  
  
  Forecasting study from 2014 to 2023 using the Cardiovascular Disease Policy Model, a Markov model.
  
  
  
  National Health and Nutrition Examination Survey.
  
  
  
  U.S. adults aged 60-94 stratified into fast walking, slow walking, and poor functioning (noncompleters) based on measured gait speed.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Odden
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Moran
authors.affiliation: Department of Medicine, University of California at San Francisco, San Francisco, California.
authors.forename: Pamela G
authors.initials: PG
authors.lastname: Coxson
authors.affiliation: Department of Medicine, University of California at San Francisco, San Francisco, California.
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Peralta
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Lee
authors.initials: L
authors.lastname: Goldman
authors.affiliation: Department of Medicine, University of California at San Francisco, San Francisco, California.|Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Bibbins-Domingo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001795:Blood Pressure Determination; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D006973:Hypertension / Q000503:physiopathology* / Q000517:prevention & control*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D009749:Nutrition Surveys; D011322:Primary Prevention; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D055502:Secondary Prevention; D014481:United States; D000072797:Walking Speed / Q000502:physiology*
keywords: Markov model; blood pressure; cost-benefit analysis; frailty; gait speed