Blood pressure and disability: first steps in future studies.
Blood pressure and disability: first steps in future studies.
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血压和残疾：未来研究的第一步。
DOI：
10.1161/hypertensionaha.107.109553
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Elias,MerrillF
中科院分区：
文献类型：
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作者：
Robbins,MichaelA;Elias,PenelopeK;Elias,MerrillF
在12月出版的《高血压》杂志中，Hajjar等人1报道，在无卒中的老年人中，收缩压（BP）的纵向升高与功能性残疾的较高风险相关，这是通过运动强度、活动性和日常生活活动的自我报告测量进行评估的。我们敦促研究人员在未来的研究中也包括可观察到的身体表现指标，因为简单的表现任务的缺陷可能预示着BP相关的功能障碍。缅因州-锡拉丘兹的BP 2研究使用了3种预测日常生活依赖性活动的身体表现指标3：（1）从硬背椅子上站起来和坐下3次，双臂交叉（站立）;（2）在10英尺的路程上来回行走（行走）;（3）转一整圈（转身）。从1975年开始，我们进行了6波数据收集，包括BP、BP相关的合并症，以及第6波Gill手术后的站立、行走和转身任务。3在这里，我们报告了第5波的BP值与第6波的身体表现的关系（平均间隔：5.1年;标准差：0.8年;范围：4.0至7.0年），因为我们在这些波上有必要的数据来使用Hajjar等人1使用的模型，排除中风、痴呆和透析患者，共有814名参与者（第6波平均年龄：62.4岁;标准差：12.7岁;平均受教育年限：14.7年;标准差：2.7年; 62.8%女性; 57.4%高血压受试者; 45.3%接受治疗的高血压受试者）。性能指标对收缩压（毫米汞柱）进行回归，回归系数（mmHg）乘以20表示收缩压增加20 mm Hg。校正年龄、教育和性别后，第5波收缩压增量与每项任务的第6波执行时间（秒）呈正相关（P 0.001）。当调整Hajjar等人使用的协变量1，即年龄、教育、性别、种族、体重指数、吸烟、饮酒、糖尿病、关节炎和心血管疾病时，较高的血压与较差的表现之间的相关性仍然具有统计学显著性：（1）站立（β 0. 26; SE0. 09）;（2）行走（ß 0. 12; SE0. 06）;（3）转弯（β 0. 08; SE0. 04）。当重复分析时，两个协变量模型的结果都得到了复制，其中血压测量与第6波时的体能同时进行。与Hajjar等人一致，1舒张压与性能无关。排除45岁以上人群的结果相同。我们没有发现收缩压从第5波上升到第6波与第6波时的体力活动相关。这可能与以下事实有关：与Hajjar等人1报告的许多日常生活活动测量相比，这些体力任务的复杂性和难度较低。然而，我们确实看到收缩压与可预测残疾的可观察性能测量之间存在强大的前瞻性和并发性相关性。因此，我们鼓励研究者在未来的研究中使用基本的身体性能指标，包括日常生活活动指标和Hajjar等人的工作所例证的积极纵向设计特征。
In the December issue of Hypertension, Hajjar et al1 report that, in stroke-free older adults, longitudinal increases in systolic blood pressure (BP) were related to higher risk of functional disability as assessed by self-report measures of motor strength, mobility, and activities of daily living. We urge investigators to also include observable indices of physical performance in future studies, because deficits in simple performance tasks may herald BP-related functional disability. The Maine-Syracuse study of BP2 used 3 measures of physical performance that predict activities of daily living dependence3:(1) standing up and sitting down from a hard-backed chair 3 times with arms folded (standing);(2) walking back and forth over a 10-foot course (walking); and (3) turning full circle (turning). Beginning in 1975, we conducted 6 waves of data collection, including BP, BP-related comorbidities, and, at wave 6, the standing, walking, and turning tasks following the Gill procedure. 3 Here we report BP values at wave 5 in relation to physical performance at wave 6 (mean interval: 5.1 years; SD: 0.8 years; range: 4.0 to 7.0 years), because we have the necessary data at these waves to use the models used by Hajjar et al. 1 Excluding stroke, dementia, and dialysis patients, there were 814 participants (wave 6 mean age: 62.4 years; SD: 12.7 years; mean education: 14.7 years; SD: 2.7 years; 62.8% women; 57.4% hypertensive subjects; 45.3% treated hypertensive subjects). The performance measures were regressed on systolic BP (millimeters of mercury) with regression coefficients (ß) multiplied by 20 to express 20-mm Hg increments in systolic BP. With adjustment for age, education, and gender, increments in systolic BP at wave 5 were positively related to wave 6 performance time in seconds for each task (P 0.001). These associations of higher BP with poorer performance remained statistically significant when adjusted for covariates used by Hajjar et al, 1 ie, age, education, gender, race, body mass index, smoking, alcohol consumption, diabetes, arthritis, and cardiovascular disease:(1) standing (ß0. 26; SE0. 09);(2) walking (ß0. 12; SE0. 06); and (3) turning (ß0. 08; SE0. 04). Findings with both covariate models were replicated when analyses were repeated with BP measured concurrently with physical performance at wave 6. Consistent with Hajjar et al, 1 diastolic BP was not associated with performance. Results were the same with exclusion of people 45 years of age. We did not find that rise in systolic BP from wave 5 to wave 6 was associated with physical performance at wave 6. This may relate to the fact that these physical tasks were less complex and less difficult to perform than many of the activities of daily living measures reported by Hajjar et al. 1 However, we do see robust prospective and concurrent associations between systolic BP and observable performance measures predictive of disability. Thus, we encourage investigators to use basic physical performance measures in future investigations that include activities of daily living measures and the positive longitudinal design features exemplified by the work of Hajjar et al. 1