Effect of Intensive Blood Pressure Control on Gait Speed and Mobility Limitation in Adults 75 Years or Older A Randomized Clinical Trial
Effect of Intensive Blood Pressure Control on Gait Speed and Mobility Limitation in Adults 75 Years or Older A Randomized Clinical Trial
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DOI：
10.1001/jamainternmed.2016.9104
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发表时间：
2017-04-01
影响因子：
39
通讯作者：
Pajewski, Nicholas M.
中科院分区：
文献类型：
--
作者：
Odden, Michelle C.;Peralta, Carmen A.;Pajewski, Nicholas M.
目的研究强化血压控制对步态速度和活动状态改变的影响。设计、设置和参与者：这项随机临床试验包括2636名75岁或以上的高血压患者，他们没有2型糖尿病或中风病史，参与了收缩压干预试验(SPRINT)。数据收集时间为2010年11月8日至2015年12月1日。根据治疗意向进行分析。干预组参与者被随机分成强化治疗组和标准治疗组，前者的收缩压目标小于120 mm Hg(n=1317)，后者的血压目标小于140 mm Hg(n=1319)。关于行动能力的自我报告信息来自退伍军人兰德12项健康调查和EQ-5D。活动受限定义为步态速度小于0.6m/s(m/S)或自我报告的行走和爬楼梯受限。结果在可确定活动状态的2629名参与者中，女性996名(37.9%)，男性1633名(62.1%)，平均[SD]年龄79.9[4.0]岁，中位(四分位数范围)随访3(2-3)年。强化治疗组和标准治疗组之间的平均步速下降没有差异(平均差异，0.0004米/S/年；95%可信区间，-0.005~0.005；P=0.88)。未发现治疗组在年龄、性别、种族或民族、基线收缩压、慢性肾脏疾病或心血管疾病病史定义的亚组中存在任何差异的证据。退伍军人健康调查12项身体成分总分存在适度交互作用，但两个亚组的影响均未达到统计学意义，得分在40分以上者平均每年相差0.004(95%CI，-0.002~0.010)m/S，低于40分者年均相差-0.008(95%CI，-0.016~0.001)m/S(交互作用P=0.03)。考虑死亡竞争风险的多状态模型显示，强化治疗对过渡到活动受限没有影响(风险比，1.06；95%可信区间，0.92-1.22)。结论：75岁或75岁以上的成年人在短跑中，将收缩压目标控制在120毫米汞以下，与低于140毫米汞的目标相比，对步态速度的变化没有影响，也与活动受限的变化无关。
IMPORTANCE Intensive blood pressure (BP) control confers a benefit on cardiovascular morbidity and mortality; whether it affects physical function outcomes is unknown.OBJECTIVE To examine the effect of intensive BP control on changes in gait speed and mobility status.DESIGN, SETTING, AND PARTICIPANTS This randomized, clinical trial included 2636 individuals 75 years or older with hypertension and no history of type 2 diabetes or stroke who participated in the Systolic Blood Pressure Intervention Trial (SPRINT). Data were collected from November 8, 2010, to December 1, 2015. Analysis was based on intention to treat.INTERVENTIONS Participants were randomized to intensive treatment with a systolic BP target of less than 120 mm Hg (n = 1317) vs standard treatment with a BP target of less than 140 mm Hg (n = 1319).MAIN OUTCOMES AND MEASURES Gait speed was measured using a 4-mwalk test. Self-reported information concerning mobility was obtained from items on the Veterans RAND 12-Item Health Survey and the EQ-5D. Mobility limitation was defined as a gait speed less than 0.6 meters per second (m/s) or self-reported limitations in walking and climbing stairs.RESULTS Among the 2629 participants in whom mobility status could be defined (996 women [37.9%]; 1633 men [62.1%]; mean [SD] age, 79.9 [4.0] years), median (interquartile range) follow-up was 3 (2-3) years. No difference in mean gait speed decline was noted between the intensive-and standard-treatment groups (mean difference, 0.0004 m/s per year; 95% CI, -0.005 to 0.005; P = .88). No evidence of any treatment group differences in subgroups defined by age, sex, race or ethnicity, baseline systolic BP, chronic kidney disease, or a history of cardiovascular disease were found. A modest interaction was found for the Veterans RAND 12-Item Health Survey Physical Component Summary score, although the effect did not reach statistical significance in either subgroup, with mean differences of 0.004 (95% CI, -0.002 to 0.010) m/s per year among those with scores of at least 40 and -0.008 (95% CI, -0.016 to 0.001) m/s per year among those with scores less than 40 (P = .03 for interaction). Multistate models allowing for the competing risk of death demonstrated no effect of intensive treatment on transitions to mobility limitation (hazard ratio, 1.06; 95% CI, 0.92-1.22).CONCLUSIONS AND RELEVANCE Among adults 75 years or older in SPRINT, treating to a systolic BP target of less than 120mmHg compared with a target of less than 140 mm Hg had no effect on changes in gait speed and was not associated with changes in mobility limitation.