High blood pressure doesn’t indicate mortality risk in inactive elderly patients

New research from Oregon State University (OSU) suggests that older adults with elevated blood pressure are not at a high risk of death if they have a weak grip or are generally inactive, an important finding for physicians treating hypertension in these patients.

This study builds on earlier work by the college that showed the relationship between hypertension and death largely depends on how frail the elderly patient is. In this study, frailty was measured by how fast the patients could walk.

In the new study, published in the Journal of the American Geriatrics Society, researchers found that when an elderly person is very active and mobile, high blood pressure indicates a risk for death. But in slower-moving patients, high blood pressure does not necessarily indicate mortality risk.

"If people are very frail, they typically don't respond well to anti-hypertensive therapy, and they are not benefiting from having a low blood pressure," said Chenkai Wu, the lead author on the study and a graduate student in OSU's College of Public Health and Human Sciences, in a statement. "The research is basically saying older adults are not one single group; they're very different in terms of their health status. And drugs may not have the same benefits for everyone. This is consistent with the idea of precision medicine, where you don't just look at age, you look at other things like functional status."

The investors reached their conclusions after looking at data from more than 7,400 people aged 65 and older who participated in the Health and Retirement Study. During the six years following the survey, 25 percent of them died. The data showed that elevated systolic blood pressure and diastolic blood pressure were associated with a higher chance of dying in patients with normal grip strength.

"We did three analyses," Wu said. "One was to look at gait speed to separate people into two groups—normal and slow. The second part was grip strength—weak grip and normal grip. Third, we looked at the combinations, and the strongest inverse association between high blood pressure and mortality was for slow walkers with weak grip strength. Both measures are markers of functional status, a multidimensional concept. Considering both might be better than considering each measure alone for identifying subgroups of elders for whom high blood pressure is potentially beneficial."