Hypertension May Have Direct Effects on Disability, Even in Stroke-Free Subjects

Shelley Wood

November 19, 2007

November 19, 2007 (Charleston, SC) - Uncontrolled hypertension
likely has a direct effect on disability and functional status in older adults, even those who are stroke-free with no other major diseases linked to high blood pressure, a new study suggests [1]. High systolic blood pressure was linked not only to the development of disability in people with no functional problems earlier in life but also to more rapid functional decline in people with mild or moderate disability at a younger age.

"Previous research has concentrated on the fact that hypertension leads to stroke, and stroke leads to disability from neurological loss," lead author on the study, Dr Ihab Hajjar (Harvard Medical School, Boston, MA), told heart wire . "The independent association between high blood pressure and loss of function has not been addressed before, although it makes sense that it would [play a role]. This gives us some additional evidence that hypertension may affect some functional aspects that we don't usually think of."

The study appears in the November 20, 2007 issue of Hypertension.

Blood-pressure impact on day-to-day life

Hajjar and colleagues looked at a stroke-free, multiracial population participating in the Charleston Heart Study--999 subjects in total--followed between 1960 and 1993. A variety of tests used to assess functional status were performed over the three decades of the study, as were measurements of systolic and diastolic blood-pressure levels at baseline and over the follow-up period. Functional tests measured everything from physical strength (pushing, pulling, lifting, etc) to mobility indexes (walking, using a wheelchair), to personal-hygiene ability (bathing, grooming, dressing, etc).

Hajjar and colleagues found that increases in systolic blood pressure (but not diastolic blood pressure) over time were associated with functional disability at follow-up, even in subjects with no disability at study outset. Subjects with mild disability at baseline who had uncontrolled systolic hypertension at different points during the study were more likely to experience more rapid functional decline than people without hypertension.

"We found that blood pressure is not only associated with new disability, but also with a more rapid decline in function, which was somewhat surprising to us," Hajjar commented. "It definitely adds more evidence that the association is real and alarming."

Importantly, however, men and women diagnosed with hypertension who successfully lowered their blood pressure to target levels faced a much lower risk of developing disabilities--more or less equal to that of people with no hypertension in the study.

"The lack of association between controlled hypertension and disability risk suggests that adequate control of hypertension may prevent functional decline," the authors write. "However, this could also be related to the small sample size of those with controlled hypertension" and will need to be further explored in larger studies. Women appeared even more likely to develop disability from hypertension than men, and since hypertension is more common in women than men, this may be one explanation for the higher rates of disability in women than in men, they add.

To heart wire , Hajjar emphasized that cardiologists may need to tweak their thinking about hypertension. "We always think of blood pressure and hypertension as risk factors for cardiovascular types of outcomes: we think of stroke, congestive heart failure, CAD, and renal failure. But our study enlarges the extent of damage that hypertension causes in our patients, specifically in older patients who, even without hypertension, are already at an increased risk of developing loss of function. And even if we look at hypertensive individuals earlier in life, they were more likely to have these types of functional losses."

  1. Hajjar I, Lackland D, Cupples LA, Lisitz LA. Association between concurrent and remote blood pressure and disability in older adults. Hypertension 2007; DOI: 10.1161/HYPERTENSIONAHA.107.097667. Available at: http://hyper.ahajournals.org.

The complete contents of Heart wire , a professional news service of WebMD, can be found at www.theheart.org, a Web site for cardiovascular healthcare professionals.


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