Odden Michelle C, Peralta Carmen A, Berlowitz Dan R, Johnson Karen C, Whittle Jeffrey, Kitzman Dalane W, Beddhu Srinivasan, Nord John W, Papademetriou Vasilios, Williamson Jeff D, Pajewski Nicholas M
School of Biological and Population Health Sciences, Oregon State University, Corvallis.
Department of Medicine, University of California, San Francisco.
JAMA Intern Med. 2017 Apr 1;177(4):500-507. doi: 10.1001/jamainternmed.2016.9104.
Intensive blood pressure (BP) control confers a benefit on cardiovascular morbidity and mortality; whether it affects physical function outcomes is unknown.
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.
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).
Gait speed was measured using a 4-m walk 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.
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).
Among adults 75 years or older in SPRINT, treating to a systolic BP target of less than 120 mm Hg 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.
clinicaltrials.gov Identifier: NCT01206062.
强化血压控制对心血管疾病的发病率和死亡率有益；但它是否会影响身体功能结局尚不清楚。
研究强化血压控制对步态速度和活动能力状态变化的影响。
设计、地点和参与者：这项随机临床试验纳入了2636名75岁及以上的高血压患者，他们无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。分析基于意向性治疗原则。
参与者被随机分为强化治疗组，收缩压目标小于120 mmHg（n = 1317）和标准治疗组，血压目标小于140 mmHg（n = 1319）。
使用4米步行试验测量步态速度。从退伍军人兰德12项健康调查和EQ - 5D的项目中获取有关活动能力的自我报告信息。活动能力受限定义为步态速度小于每秒0.6米（m/s）或自我报告的行走和爬楼梯受限。
在2629名可定义活动能力状态的参与者中（996名女性[37.9%]；1633名男性[62.1%]；平均[标准差]年龄，79.9[4.0]岁），中位（四分位间距）随访时间为3（2 - 3）年。强化治疗组和标准治疗组之间的平均步态速度下降无差异（平均差异，每年0.00
