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

• Published in: Journal of the American Geriatrics Society (JAGS) 2016-05, Vol.64 (5), p.1015-1023
• Main Authors: Odden, Michelle C., Moran, Andrew E., Coxson, Pamela G., Peralta, Carmen A., Goldman, Lee, Bibbins-Domingo, Kirsten
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; blood pressure; Blood Pressure Determination; cost-benefit analysis; Female; frailty; gait speed; Geriatric Assessment; Humans; Hypertension - physiopathology; Hypertension - prevention & control; Male; Markov Chains; Markov model; Middle Aged; Nutrition Surveys; Primary Prevention; Quality-Adjusted Life Years; Risk Assessment; Secondary Prevention; United States; Walking Speed - physiology
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.14084

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