Walking speeds the way to understanding elderly blood pressure

By Piriya Mahendra

The first study to examine walking speed, mortality, and blood pressure has shown that frail, elderly adults who have high blood pressure (BP) may actually be at a decreased risk for mortality, write researchers in the Archives of Internal Medicine.

The observation has long been "one of the best kept secrets in medicine" according to editorialist James Goodwin (University of Texas, USA). He says the current study by Michelle Odden (Oregon State University, USA) and team highlights why "current guideline-based care is inappropriate for octogenarians."

The analysis showed that the association between BP and mortality varied by walking speed, which the authors used as a measure of frailty. In fast walkers (≥0.8 m/s), or more robust individuals, those with an elevated systolic BP (≥140 mmHg) had a 35% higher risk for mortality than those without.

However, in slow walkers (<0.8 m/s), neither elevated systolic nor diastolic BP (≥90 mmHg) were significantly associated with mortality.

Of note, participants who could not complete the walk test and had an elevated systolic and diastolic BP were at a 62% and 90% reduced risk for dying, respectively.

All participants were aged 65 years or more.

"As we age, our blood vessels lose elasticity and become stiff," remarked Odden in a press statement. "Higher BP could be a compensatory mechanism to overcome this loss of vascular elasticity and keep fresh blood pumping to the brain and heart."

She explained that the difference in mortality rate between fast, slow and nonwalkers can simply be explained by the fact that everyone ages differently.

"There is a profound difference in the physiological age of an 80-year-old man who golfs every day, and someone who needs a walker to get around," she said. "So in the fast walkers, high BP may be more indicative of underlying disease, not just a symptom of the aging process."

However, since this is one of the first studies to examine gait speed, BP, and mortality, Odden warned against individuals making health decisions based on the findings.

"Any sort of decision regarding medication use should be done in consultation with a physician," she cautioned.

"Our study supports treating high BP in healthy, active older adults. But in frail older adults, with multiple chronic health conditions, we need to take a closer look at what sorts of effects high BP could serve and whether having a higher BP could be protective."

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