Systolic and Diastolic Blood Pressure, Incident Cardiovascular Events and Death in Elderly Persons: The Role of Functional Limitation Public Deposited

http://ir.library.oregonstate.edu/concern/articles/9g54xk596

This is an author's peer-reviewed final manuscript, as accepted by the publisher. The published article is copyrighted by the American Heart Association, Inc., and published in conjunction with Lippincott, Williams & Wilkins. It can be found at:  http://hyper.ahajournals.org/

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  • Systolic and Diastolic Blood Pressure, Incident Cardiovascular Events and Death in Elderly Persons: The Role of Functional Limitation in the Cardiovascular Health Study
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  • BACKGROUND: Whether limitation in ability to perform activities of daily living (ADL) or gait speed can identify subgroups of elders in whom the association of systolic (SBP) and diastolic (DBP) blood pressure with cardiovascular events and death differs is not well established. METHODS: We evaluated whether ADL and gait speed modify the association of SBP or DBP with incident cardiovascular (CV) events (N= 2,358) and all-cause death (N=3,547) among participants in the 7th visit of the Cardiovascular Health Study. We used multivariable Cox regression adjusting for potential confounders. RESULTS: Mean age was 78 ± 5 years and 21% reported limitation in ≥1 ADL. There were 778 incident CV events and 1,289 deaths over approximately 9 years. Among persons without and with ADL limitation, SBP was directly associated CVD events, and the size of the HRs was similar in the two groups: HR (per 10 mmHg increase) 1.08 (95% CI 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 limitations, DBP was weakly associated with CVD, HR 1.04 (0.79, 1.37) for DBP > 80 compared to < 65. In contrast, among those with ADL limitation, DBP was inversely associated with CVD events. HR 0.65 (0.44, 0.96) for DBP 66-80 mmHg and HR 0.49 (0.25, 0.94) for DBP > 80 mmHg, compared to DBP ≤ 65 mmHg. Among persons with ADL limitation, a DBP 66-80 had the lowest risk for death, HR 0.72 (0.57, 0.91), compared with DBP ≤ 65 mmHg. Associations of BP with CVD or death did not vary by 15 feet walking speed. CONCLUSIONS: ADL can identify the subgroups of elders in whom diastolic hypotension is associated with higher CV risk and death. Functional status, rather than chronologic age, should inform design of trials to elucidate benefits and harms of lowering each BP component in elders.
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  • Peralta, C. A., Katz, R., Newman, A. B., Psaty, B. M., & Odden, M. C. (2014). Systolic and Diastolic Blood Pressure, Incident Cardiovascular Events, and Death in Elderly Persons The Role of Functional Limitation in the Cardiovascular Health Study. Hypertension, 64(3), 472-480. doi:10.1161/HYPERTENSIONAHA.114.03831
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  • description.provenance : Submitted by Deanne Bruner (deanne.bruner@oregonstate.edu) on 2015-01-10T00:58:31Z No. of bitstreams: 1 OddenMichellePublicHealthHumanSciencesSystolicDiastolicBloodPressure.pdf: 477793 bytes, checksum: 78177b295f840bec090d468ad7b15402 (MD5)
  • description.provenance : Approved for entry into archive by Deanne Bruner(deanne.bruner@oregonstate.edu) on 2015-01-10T01:00:17Z (GMT) No. of bitstreams: 1 OddenMichellePublicHealthHumanSciencesSystolicDiastolicBloodPressure.pdf: 477793 bytes, checksum: 78177b295f840bec090d468ad7b15402 (MD5)
  • description.provenance : Made available in DSpace on 2015-01-10T01:00:17Z (GMT). No. of bitstreams: 1 OddenMichellePublicHealthHumanSciencesSystolicDiastolicBloodPressure.pdf: 477793 bytes, checksum: 78177b295f840bec090d468ad7b15402 (MD5) Previous issue date: 2014-09

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