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 “Intensive blood pressure control does not appear to have an
important effect on short-term gait speed decline among older
adults,” Dr. Nicholas Pajewski of Wake Forest School of Medicine in
Winston-Salem, North Carolina, and colleagues note in their JAMA
Internal Medicine report, online February 6.
SPRINT showed that targeting a systolic BP of <120 mm Hg has
benefits on cardiovascular illness and death in hypertensive adults
aged 50 and older with no history of type 2 diabetes or stroke. This
benefit was seen in adults 75 and older and, in exploratory
analyses, in those with frailty or slow gait speed. But whether
intensive BP control affects physical function outcomes is unknown,
the researchers say.
To investigate, they compared the trajectory of gait speed decline
and new mobility limitation in the subgroup aged 75 and older
randomized to intensive and standard BP control arms of SPRINT. They
had gait speed data for about 1,300 subjects in each study arm and
mobility data for 1,250 in each arm.
During a median follow-up of three years, there were no
between-group differences in decline in gait speed. In both groups,
the average rate of gait speed decline was about 0.08 m/s across
follow-up.
In addition, intensive BP treatment was not associated with changes
in mobility limitation compared with standard treatment.
“These findings were robust to statistical attempts to account for
missing data and the competing risk for death,” the researchers say.
“The effect of intensive lowering of BP on the change in gait speed
was consistent across subgroups defined by age, sex, race, systolic
BP, history of chronic kidney disease, and history of CVD.”
The researchers found “modest evidence” of a differential effect on
physical quality of life (QOL), such that intensive BP lowering
appeared to be associated with a slower rate of decline in gait
speed in those with better physical QOL, whereas among those with
worse physical QOL, intensive BP lowering appeared to be associated
with a faster decline in gait speed.
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“Participants with preserved physical QOL may have gained additional
benefit from intensive treatment. However, these findings should be
interpreted with caution because the effect size was modest and did
not reach statistical significance in either group,” the researchers
say.
Summing up, they say, "SPRINT is, to our knowledge, the first
large-scale randomized clinical trial of BP control to report
results concerning gait speed as an outcome. The benefits of
intensive BP lowering on cardiovascular prevention and mortality do
not appear to affect short-term mobility.”
The researchers note that SPRINT was stopped early owing to a
significantly lower rate of the primary composite outcome (risk of
death or CVD events) in the intensive-treatment group, meaning they
couldn't look at the long-term effects of intensive BP lowering on
gait and mobility outcomes.
“This early termination may have limited the trial’s power to detect
differences in gait speed or mobility limitation,” they note.
SOURCE: http://bit.ly/2jUIpaJ
JAMA Intern Med 2017.
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