Which Elders With Systolic Hypertension Should We Treat?

Thomas L. Schwenk, MD


Journal Watch 

In This Article

Abstract and Introduction


Those with fast walking speeds reap more benefit.


Control of systolic hypertension in elders is difficult and often is inadequate. Treating healthy octogenarians was beneficial in one study (JW Gen Med Apr 17 2008), but outcomes in more frail or sicker patients are unclear. U.S. researchers used walking speed as a measure of frailty to classify 2340 older patients (mean age, 74; 50% with systolic hypertension) as slow or fast walkers based on a threshold of 0.8 meters/second (about 75 feet in 30 seconds).

During 7 years of follow-up, 589 patients died: roughly 70 patients per 1000 person-years among slow walkers and 24 per 1000 person-years among fast walkers. In analyses adjusted for several demographic and clinical parameters, mortality among slow walkers did not differ by systolic hypertension status; however, among fast walkers, mortality was 35% higher in those with systolic hypertension. No association was found between mortality and diastolic hypertension in either fast or slow walkers.