Wu Chenkai, Smit Ellen, Peralta Carmen A, Sarathy Harini, Odden Michelle C
School of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon.
Department of Medicine, University of California, San Francisco, California.
J Am Geriatr Soc. 2017 Jul;65(7):1482-1489. doi: 10.1111/jgs.14816. Epub 2017 Mar 17.
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.
7,492 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, 1,870 (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 to -27%) and a 16% (95% CI, 46 to -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 was 0.85 (95% CI, 0.56-1.29) and 0.53 (95% CI, 0.30-0.96), respectively, and was substantially different from non-slow walkers with normal grip strength (HR = 1.24 and 1.15, respectively; P-values of interactions: both <.001). Therefore, 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.
研究握力、步速以及这两种身体功能指标的组合是否会改变收缩压（SBP）和舒张压（DBP）与死亡率之间的关联。
具有全国代表性的队列研究。
健康与退休研究。
7492名年龄≥65岁的美国成年人。
使用握力计测量握力，并分为正常（女性≥16千克；男性≥26千克）和虚弱。通过98.5英寸的步行评估步速，并分为非缓慢（女性≥0.60米/秒；男性≥0.52米/秒）和缓慢。
在平均6.0年的随访期内，1870名（25.0%）参与者死亡。在对社会人口统计学、行为和临床指标进行调整后，收缩压升高（≥150毫米汞柱）和舒张压升高（≥90毫米汞柱）与握力正常的参与者死亡率分别高出24%（95%置信区间，7%-43%）和25%（95%置信区间，5%-49%）相关。相比之下，收缩压和舒张压升高与握力虚弱的参与者死亡率分别低6%（95%置信区间，31%至-27%）和16%（95%置信区间，46%至-26%）相关（交互作用P值均为=0.07）。血压与死亡之间的负相关关系在握力虚弱的慢步行者中最为明显。收缩压升高和舒张压升高导致死亡的风险比分别为0.85（95%置信区间，0.56-1.29）和0.53（95%置信区间，0.30-0.96），与握力正常的非缓慢步行者有显著差异（风险比分别为1.24和1.15；交互作用P值均<0.001）。因此，血压与死亡的关联因步速而略有不同。
握力改变了血压与死亡之间的关联。握力和步速的组合对于改变血压与死亡之间的关联具有增量价值。
