High morning home blood pressure is associated with a loss of functional independence in the community-dwelling elderly aged 75 years or older

To elucidate the relationship between home systolic blood pressure (SBP) and functional impairment in the elderly 75 years or older, 461 community-dwelling subjects (192 men, 269 women, mean age: 80 years) were studied. Home blood pressure was measured twice in the morning and twice in the evening for 5 consecutive days with an automatic cuff-oscillometric device. Total/high-density lipoprotein cholesterol and several functional assessments were evaluated. A subject was determined to exhibit a loss of independence according to the activities of daily living (ADL) score in a study conducted in 2001. Based on the mean home SBPs (mSBP) and morning-evening SBP differences (dSBP), the subjects were classified into 4 groups as follows: hypertensive/morning-dominant (HM; mSBP >= 135 mmHg, dSBP >= 15 mmHg), hypertensive/sustained (HS; mSBP >= 135 mmHg, dSBP < 15 mmHg), normotensive/morning-dominant (NM; mSBP < 135 mmHg, dSBP >= 15 mmHg), and normotensive/controlled (NC; mSBP < 135 mmHg, dSBP < 15 mmHg). There were no differences in sex, cholesterol levels, history of stroke, other cardiovascular diseases (CVDs), and cognitive function, but there were significant differences in age, anti hypertensive medications, the neurobehavioral test scores, and ADL scores. There were no significant differences in terms of mortality and CVD events. In the survivors, HM and HS were independent risk factors for a loss of independence, after adjustments were made for onset of stroke, age, anti hypertensive therapy, history of CVD, as well as neurobehavioral test scores and ADL scores (odds ratio [OR]: 12.2 and 3.78, respectively). After the same adjustments as those mentioned above were made, HM and HS were found to be negative determinants of survival and maintenance of independence (OR: 0.082, 0.270, respectively). In conclusion, high home SBP (>= 135 mmHg) and high dSBP (>= 15 mmHg) were found to be important in determining the levels of disability for the very elderly.