Dataset Information

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.

SUBMITTER: Odden MC

PROVIDER: S-EPMC5030071 | biostudies-literature | 2016 May

REPOSITORIES: biostudies-literature

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Gait Speed as a Guide for Blood Pressure Targets in Older Adults: A Modeling Study.

Odden Michelle C MC Moran Andrew E AE Coxson Pamela G PG Peralta Carmen A CA Goldman Lee L Bibbins-Domingo Kirsten K

Journal of the American Geriatrics Society 20160501 5

<h4>Objectives</h4>To evaluate the potential for gait speed to inform decisions regarding optimal systolic blood pressure targets in older adults.<h4>Design</h4>Forecasting study from 2014 to 2023 using the Cardiovascular Disease Policy Model, a Markov model.<h4>Setting</h4>National Health and Nutrition Examination Survey.<h4>Participants</h4>U.S. adults aged 60-94 stratified into fast walking, slow walking, and poor functioning (noncompleters) based on measured gait speed.<h4>Measurements</h4>L ...[more]

PMID: 27225357

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Project description:Importance:Intensive blood pressure (BP) control confers a benefit on cardiovascular morbidity and mortality; whether it affects physical function outcomes is unknown. Objective:To examine the effect of intensive BP control on changes in gait speed and mobility status. Design, Setting, and Participants:This randomized, clinical trial included 2636 individuals 75 years or older with hypertension and no history of type 2 diabetes or stroke who participated in the Systolic Blood Pressure Intervention Trial (SPRINT). Data were collected from November 8, 2010, to December 1, 2015. Analysis was based on intention to treat. Interventions:Participants were randomized to intensive treatment with a systolic BP target of less than 120 mm Hg (n?=?1317) vs standard treatment with a BP target of less than 140 mm Hg (n?=?1319). Main Outcomes and Measures:Gait speed was measured using a 4-m walk test. Self-reported information concerning mobility was obtained from items on the Veterans RAND 12-Item Health Survey and the EQ-5D. Mobility limitation was defined as a gait speed less than 0.6 meters per second (m/s) or self-reported limitations in walking and climbing stairs. Results:Among the 2629 participants in whom mobility status could be defined (996 women [37.9%]; 1633 men [62.1%]; mean [SD] age, 79.9 [4.0] years), median (interquartile range) follow-up was 3 (2-3) years. No difference in mean gait speed decline was noted between the intensive- and standard-treatment groups (mean difference,?0.0004 m/s per year; 95% CI, -0.005 to 0.005; P?=?.88). No evidence of any treatment group differences in subgroups defined by age, sex, race or ethnicity, baseline systolic BP, chronic kidney disease, or a history of cardiovascular disease were found. A modest interaction was found for the Veterans RAND 12-Item Health Survey Physical Component Summary score, although the effect did not reach statistical significance in either subgroup, with mean differences of 0.004 (95% CI, -0.002 to 0.010) m/s per year among those with scores of at least 40 and -0.008 (95% CI, -0.016 to 0.001) m/s per year among those with scores less than 40 (P?=?.03 for interaction). Multistate models allowing for the competing risk of death demonstrated no effect of intensive treatment on transitions to mobility limitation (hazard ratio, 1.06; 95% CI, 0.92-1.22). Conclusions and Relevance:Among adults 75 years or older in SPRINT, treating to a systolic BP target of less than 120 mm Hg compared with a target of less than 140 mm Hg had no effect on changes in gait speed and was not associated with changes in mobility limitation. Trial Registration:clinicaltrials.gov Identifier: NCT01206062.

Dataset Information

Gait Speed as a Guide for Blood Pressure Targets in Older Adults: A Modeling Study.

Publications

Gait Speed as a Guide for Blood Pressure Targets in Older Adults: A Modeling Study.

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