Introduction:
Greater late-life physical function decline is associated with incident adverse outcomes including disability and death. Hypertension is the strongest risk factor for stroke, the major cause of physical disability. Hypertension in mid-life has previously been associated with poor physical functioning in late-life; however, more evidence is needed to evaluate whether higher blood pressure in mid-life is associated with the rate of physical function decline during late-late in the absence of stroke. We hypothesized that elevated blood pressure in mid-life would be associated with greater physical function declines in late life.
Methods:
We studied 5,559 older adults in the ARIC Study (Visit 5; mean age: 75.8 years; range: 66.7-90.9 years; 58% women; 21% Black/79% White) without prior stroke or Parkinson disease who completed the Short Physical Performance Battery (SPPB, scored 0-12). Repeated SPPB assessments occurred at Visits 6 and 7 (median follow-up: 4.2 years). The exposure was a history of elevated blood pressure (BP) (Visit 1; mean age: 52.0 years; mean gap between mid- and late-life exams: 23.7 years). BP was modeled both categorically (hypertensive: SBP 140+ mmHg, DBP 90+ mmHg, or antihypertensive medication use; pre-hypertensive: SBP 120-139 mmHg or DBP 80-89 mmHg; else normotensive) and continuously. Random-slope, random-intercept mixed models with an independent covariance structure tested the association between BP and SPPB score change, adjusted for age, sex, race-site, BMI, education, heart disease and heart failure. Continuous analysis also adjusted for antihypertensive medication use.
Results:
SPPB scores declined an average of 1.60 points per 10 years (95% CI: -1.75, -1.46; p<0.001) among older adults who were normotensive in mid-life. Older adults with a previous measurement of hypertension declined an additional 0.94 points per 10 years (95% CI: -1.27, -0.60; p<0.001). Prehypertension was not statistically significantly associated with additional decline compared to mid-life normotension (estimate: -0.19 SPPB points/10 years; 95% CI: -0.53, 0.16; p=0.293). In the continuous analysis, each additional 10 mmHg higher mid-life systolic blood pressure above 120 mmHg was associated with an additional 0.24 point decline in SPPB per 10 years in late-life (95% CI: -0.31,-0.14; p<0.001).
Conclusions:
Elevated BP in mid-life provides insight into the rate of physical function decline decades later, with higher mid-life systolic blood pressure corresponding with steeper declines in late-life physical function even in the absence of stroke. Future research should investigate whether elevated blood pressure at multiple points in mid-life further informs the association.
O1-03-02: Blood pressure, memory, and executive function changes in late-life
