Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Walking speed and high blood pressure mortality risk in a Spanish elderly population

Subjects

Abstract

This study analyzed the relationship between blood pressure and all-cause mortality according to objectively measured walking speed in a Mediterranean population-based sample of older persons. We used data from the longitudinal 'Peñagrande' Cohort Study, initiated in 2008 in a sex- and age-stratified random sample of 1250 people aged 65 years living in Madrid (Spain). A total of 814 individuals participated in the first study wave. The average of two standardized blood pressure readings was used. Walking speed was measured over a 3-m walk and classified as faster (0.8 m s−1) or slower. A total of 314 individuals were slower walkers, 475 were faster walkers and 25 did not complete the walk test. Cox proportional hazards models stratified by walking speed were used to assess the association between blood pressure and all-cause death. Non-linear relationship between BP and mortality was explored by a restricted cubic spline analysis. There were 171 deaths from study entry through 31 March 2013. Systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mmHg were associated with higher mortality than blood pressure values above 140 and 90 mm Hg, respectively, but this association reached statistical significance only for systolic blood pressure and only in the slower walkers. In conclusion, systolic blood pressure levels <140 mm Hg were found associated with higher risk of total mortality among slower walkers in an old Spaniard population cohort.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Stokes J III, Kannel WB, Wolf PA, D’Agostino RB, Cupples L . Blood pressure as a risk factor for cardiovascular disease: the Framingham Study-30 years of follow-up. Hypertension 1989; 13: I13–I18.

    Article  Google Scholar 

  2. Franklin SS, Lopez VA, Wong ND, Mitchell GF, Larson MG, Vasan RS et al. Single versus combined blood pressure components and risk for cardiovascular disease: the Framingham Heart Study. Circulation 2009; 119: 243–250.

    Article  Google Scholar 

  3. ESH/ESC Task Force for the Management of Arterial Hypertension. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). J Hypertens 2013 31 (10): 1925–1938.

  4. Turnbull F, Neal B, Ninormiva T, Alget C, Arima H, Barzi F et al. Blood pressure lowering treatment trialists’ Collaboration: Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. BMJ 2008; 336: 1121–1123.

    CAS  PubMed  Google Scholar 

  5. Beckett NS, Peters R, Fletcher AE, Staessen J, Lisheng L, Dumitrascu D et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358: 1887–1898.

    Article  CAS  Google Scholar 

  6. Aronow WS, Fleg JL, Pepine CJ, Artinian NT, Bakris G, Brown AS et al. ACCF/AHA 2011 expert Consensus Document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus documents. J Am Coll Cardiol 2011; 57 (20): 2037–2114.

    Article  Google Scholar 

  7. Glynn RJ, Field TS, Rosner B, Hebert PR, Taylor JO, Hennekens CH . Evidence for a positive linear relation between blood pressure and mortality in elderly people. Lancet 1995; 345 (8953): 825–829.

    Article  CAS  Google Scholar 

  8. Gueyffier F, Bilpitt C, Boissel JP, Shron E, Ekbom T, Fagard R et al. Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. INDANA Group. Lancet 1999; 353: 793–796.

    Article  CAS  Google Scholar 

  9. Benfante R, Reed D, Frank J . Do coronary heart disease risk factors measured in the elderly have the same predictive roles as in the middle aged? Ann Epidemiol 1992; 2: 273–282.

    Article  CAS  Google Scholar 

  10. Langer R, Ganiats T, Barrett-Connor E . Paradoxical survival of elderly men with high blood pressure. BMJ 1989; 298: 1356–1358.

    Article  CAS  Google Scholar 

  11. Bangalore S, Messerli FH, Wun C-C, Zuckerman AL, DeMicco D, Kostis JB et al. J-curve revisited: an analysis of blood pressure and cardiovascular events in the treating to new targets (TNT) Trial. Eur Hear J 2010; 31 (23): 2897–2908.

    Article  CAS  Google Scholar 

  12. Gutiérrez-Misis A, Sánchez-Santos MT, Banegas JR, Zunzunegui MV, Sánchez-Martínez M, Castell MV . Association between blood pressure and mortality in a Spanish Cohort of persons aged 65 years or over: a dynamic model. Rev Esp Cardiol 2013; 66 (6): 464–471.

    Article  Google Scholar 

  13. Kannel WB, Vasan RS . The J-curve relationship of treated diastolic blood pressure to mortality risk: Is it real? Is it clinically meaningful? Curr Cardiovasc Risk Rep 2007; 1 (3): 204–208.

    Article  Google Scholar 

  14. Casiglia E, Mazza A, Tikhonoff V, Pavei A, Privato G, Schenal N et al. Weak effect of hypertension and other classic risk factors in the elderly who have already paid their toll. J Hum Hypertens. 2002; 16 (1): 21–31.

    Article  CAS  Google Scholar 

  15. Goodwin JS . Gait speed: comment on “rethinking the association of high blood pressure with mortality in elderly adults”. Arch Intern Med. 2012; 172 (15): 1168–1169.

    Article  Google Scholar 

  16. Diehr P, Williamson J, Burke GL, Psaty BM . The aging and dying processes and the health of older adults. J Clin Epidemiol 2002; 55 (3): 269–278.

    Article  Google Scholar 

  17. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56 (3): M146–M156.

    Article  CAS  Google Scholar 

  18. Studenski S, Perera S, Patel K, Rosano C, Faulkner K, Inzitari M et al. Gait speed and survival in older adults. JAMA 2011; 305 (1): 50–58.

    Article  CAS  Google Scholar 

  19. Abellan van Kan G, Rolland Y, Andrieu S, Bauer J, Beauchet O, Bonnefoy M et al. Gait speed at usual pace as a predictor of adverse outcomes in community dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging 2009; 13 (10): 881–889.

    Article  CAS  Google Scholar 

  20. Cesari M, Kritchevsky SB, Penninx BW, Nicklas BJ, Simonsick EM, Newman AB et al. Prognostic value of usual gait speed in well-functioning older people-results from the Health, Aging and Body Composition Study. J Am Geriatr Soc 2005; 53 (10): 1675–1680.

    Article  Google Scholar 

  21. Odden MC, Covinsky KE, Neuhaus JM, Mayeda ER, Peralta CA, Haan MN . The association of blood pressure and mortality differs by self-reported walking speed in older Latinos. J Gerontol A Biol Sci Med Sci 2012; 67 (9): 977–983.

    Article  Google Scholar 

  22. Odden MC, Peralta CA, Haan MN, Covinsky KE . Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med 2012; 172 (15): 1162–1168.

    Article  Google Scholar 

  23. Rozzini R, Trabucchi M . Gait speed and high blood pressure. JAMA Intern Med 2013; 173 (4): 324–325.

    Article  Google Scholar 

  24. Castell MV, Sánchez M, Julián R, Queipo R, Martín S, Otero Á . Frailty prevalence and slow walking speed in persons age 65 and older: implications for primary care. BMC Fam Pract 2013; 14: 86.

    Article  Google Scholar 

  25. Castell Alcalá MV, Otero Puime A, Sánchez Santos MT, Garrido Barral A, González Montalvo JI, Zunzunegui MV . Prevalence of frailty in an elderly Spanish urban population. Relationship with comorbidity and disability. Aten Primaria. 2010; 42 (10): 520–527.

    Article  Google Scholar 

  26. Radloff L . The CES-D scale: A self report depression scale for research in the general population. Appl Psychol Meas 1977; 1: 385–401.

    Article  Google Scholar 

  27. Pfeiffer E . A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 1975; 23 (10): 433–441.

    Article  CAS  Google Scholar 

  28. Little MO . Hypertension: how does management change with aging? Med Clin North Am 2011; 95 (3): 525–537.

    Article  Google Scholar 

  29. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J et al2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311 (5): 507–520.

    Article  CAS  Google Scholar 

  30. Ungar A, Pepe G, Lambertucci L, Fedeli A, Monami M, Mannucci E et al. Low diastolic ambulatory blood pressure is associated with greater all-cause mortality in older patients with hypertension. J Am Geriatr Soc 2009; 57 (2): 291–296.

    Article  Google Scholar 

  31. Ferro G, Duilio C, Spinelli L, Liucci GA, Mazza F, Indolfi C . Relation between diastolic perfusion time and coronary artery stenosis during stress-induced myocardial ischemia. Circulation 1995; 92 (3): 342–347.

    Article  CAS  Google Scholar 

  32. Flegal KM, Graubard BI, Williamson DF, Cooper RS . Reverse causation and illness-related weight loss in observational studies of body weight and mortality. Am J Epidemiol 2011; 173 (1): 1–9.

    Article  Google Scholar 

  33. McMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J et al. Blood pressure, stroke, and coronary heart disease: part 1. Prolonged differences in blood pressure; prospective observational studies corrected for the regression dilution bias. Lancet 1990; 335: 765–774.

    Article  Google Scholar 

Download references

Acknowledgements

We thank the elderly people participating in the Peñagrande Study for their generous contribution. This work was supported by the National Fund for Health Research (Fondo de Investigaciones en Salud) of Spain (project numbers FIS: PI 09/2143) and RETICEF (Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad, RD 06/0013/1013 and RD12/0043/0019).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A Gutiérrez-Misis.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gutiérrez-Misis, A., Sánchez-Santos, M., Banegas, J. et al. Walking speed and high blood pressure mortality risk in a Spanish elderly population. J Hum Hypertens 29, 566–572 (2015). https://doi.org/10.1038/jhh.2015.32

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2015.32

This article is cited by

Search

Quick links