Functional Status Modifies the Association of Blood Pressure with Death in Elders: Health and Retirement Study.
Functional Status Modifies the Association of Blood Pressure with Death in Elders: Health and Retirement Study.
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DOI：
10.1111/jgs.14816
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发表时间：
2017-07
影响因子：
6.3
通讯作者：
Odden MC
中科院分区：
文献类型：
--
作者：
Wu C;Smit E;Peralta CA;Sarathy H;Odden MC
研究握力、步态速度以及两种身体功能指标的组合是否改变了收缩压（SBP）和舒张压（DBP）与死亡率的相关性。全国代表性队列研究。健康与退休研究7492名年龄≥65岁的美国成年人。通过手部测力计测量握力，并将其分类为正常（女性≥16 kg;男性≥26 kg）和弱。在98.5英寸步行中评估步态速度，并将其分类为非缓慢（女性≥0.60 m/s;男性≥0.52 m/s）和缓慢。在平均6.0年的随访时间内，1870名（25.0%）参与者死亡。调整社会人口统计学、行为学和临床指标后，在握力正常的受试者中，SBP（≥150 mmHg）和DBP（≥90 mmHg）升高分别与死亡率增加24%（95%CI，7%，43%）和25%（95%CI，5%，49%）相关。相比之下，SBP和DBP升高与握力较弱的患者死亡率降低6%（95%CI，31%，−27%）和16%（95%CI，46%，−26%）相关（相互作用的P值：均= 0.07）。血压与死亡之间的反比关系在握力弱的慢走者中最为明显。SBP和DBP升高导致死亡的HR分别为0.85（95%CI，0.56-1.29）和0.53（95%CI，0.30-0.96），与握力正常的非慢速步行者有显著差异（HR分别为1.24和1.15;相互作用的P值：均<.001）。血压与死亡的关联因步态速度而略有不同。握力改变了血压与死亡的相关性。握力和步速的组合对于改变血压与死亡的关联具有增量价值。
To examine whether grip strength, gait speed, and the combination of the two physical functioning measures modified the association of systolic BP (SBP) and diastolic BP (DBP) with mortality. Nationally representative cohort study. Health and Retirement Study. 7492 U.S. adults aged ≥65 years. Grip strength was measured by a hand dynamometer and classified as normal (≥16 kg for female; ≥26 kg for male) and weak. Gait speed was assessed over a 98.5-inch walk and classified as non-slow (≥0.60 m/s for female; ≥0.52 m/s for male) and slow. Over an average follow-up time of 6.0 years, 1870 (25.0%) participants died. After adjustment for socio-demographic, behavioral, and clinical measures, elevated SBP (≥150 mmHg) and DBP (≥90 mmHg) was associated with a 24% (95%CI, 7%, 43%) and 25% (95%CI, 5%, 49%) higher mortality among participants with normal grip strength. In contrast, elevated SBP and DBP was associated with a 6% (95% CI, 31%, −27%) and a 16% (95%CI, 46%, −26%) lower mortality among those with weak grip strength (P-values of interactions: both=.07). The inverse relations between BP with death were most pronounced among slow walkers with weak grip strength. The HRs of elevated SBP and DBP for death were 0.85 (95%CI, 0.56–1.29) and 0.53 (95%CI, 0.30–0.96), respectively, and were substantially different from non-slow walkers with normal grip strength (HR=1.24 and 1.15, respectively; P-values of interactions: both<.001). Associations of BP with death varied modestly by gait speed. Grip strength modified the association of BP with death. Combination of grip strength and gait speed has incremental value for modifying the association of BP with death.
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作者：
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