High Blood Pressure Accelerates Gait Slowing in Well-Functioning Older Adults over 18-Years of Follow-Up

Authors

  • Caterina Rosano MD,

    1. From the *Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; and Departments ofNeurology and Epidemiology, University of Washington, Seattle, Washington.
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  • William T. Longstreth Jr MD,

    1. From the *Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; and Departments ofNeurology and Epidemiology, University of Washington, Seattle, Washington.
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  • Robert Boudreau PhD,

    1. From the *Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; and Departments ofNeurology and Epidemiology, University of Washington, Seattle, Washington.
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  • Christopher A. Taylor PhD,

    1. From the *Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; and Departments ofNeurology and Epidemiology, University of Washington, Seattle, Washington.
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  • Yan Du MS,

    1. From the *Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; and Departments ofNeurology and Epidemiology, University of Washington, Seattle, Washington.
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  • Lewis H. Kuller MD, DrPH,

    1. From the *Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; and Departments ofNeurology and Epidemiology, University of Washington, Seattle, Washington.
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  • Anne B. Newman MD

    1. From the *Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; and Departments ofNeurology and Epidemiology, University of Washington, Seattle, Washington.
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Address correspondence to Caterina Rosano, Associate Professor of Epidemiology, Department of Epidemiology, University of Pittsburgh, Center for Aging and Population Health, 130 N. Bellefield Street, Room 512, Pittsburgh, PA 15213. E-mail: rosanoc@edc.pitt.edu

Abstract

OBJECTIVES: To examine whether the association between hypertension and decline in gait speed is significant in well-functioning older adults and whether other health-related factors, such as brain, kidney, and heart function, can explain it.

DESIGN: Longitudinal cohort study.

SETTING: Cardiovascular Health Study.

PARTICIPANTS: Of 2,733 potential participants with a brain magnetic resonance imaging (MRI) scan, measures of mobility and systolic blood pressure (BP), no self-reported disability in 1992 to 1994 (baseline), and with at least 1 follow-up gait speed measurement through 1997 to 1999, 643 (aged 73.6, 57% female, 15% black) who had received a second MRI in 1997 to 1999 and an additional gait speed measure in 2005 to 2006 were included.

MEASUREMENTS: Mixed models with random slopes and intercepts were adjusted for age, race, and sex. Main explanatory factors included white matter hyperintensity progression, baseline cystatin-C, and left cardiac ventricular mass. Incidence of stroke and dementia, BP trajectories, and intake of antihypertensive medications during follow-up were tested as other potential explanatory factors.

RESULTS: Higher systolic BP was associated with faster rate of gait speed decline in this selected group of 643 participants, and results were similar in the parent cohort (N=2,733). Participants with high BP (n=293) had a significantly faster rate of gait speed decline than those with baseline BP less than 140/90 mmHg and no history of hypertension (n=350). Rates were similar for those with history of hypertension who were uncontrolled (n=110) or controlled (n=87) at baseline and for those who were newly diagnosed (n=96) at baseline. Adjustment for explanatory factors or for other covariates (education, prevalent cardiovascular disease, physical activity, vision, mood, cognition, muscle strength, body mass index, osteoporosis) did not change the results.

CONCLUSION: High BP accelerates gait slowing in well-functioning older adults over a long period of time, even for those who control their BP or develop hypertension later in life. Health-related measurements did not explain these associations. Future studies to investigate the mechanisms linking hypertension to slowing gait in older adults are warranted.

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