Abstract P345: Long-Term Blood Pressure Variability and Physical Performance Measures in Community-Dwelling Older Adults

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High degrees of long-term, visit-to-visit blood pressure variability (BPV) independently predict increased risks of cardiovascular disease, cognitive decline, and frailty in older adults. Measures of physical performance such as gait speed and grip strength can predict loss of independence and mortality in older adults, but are not routinely measured in practice. Shared pathways of underlying physiologic deterioration may exist between high BPV and progressive loss of gait speed and grip strength. We examined the association between long term, visit-to-visit BPV and change in gait speed and grip strength in participants of the ASPirin in Reducing Events in the Elderly (ASPREE) study, a randomized primary prevention trial of low-dose aspirin conducted in 19,114 community-dwelling adults in Australia and the U.S. who were without independence-limiting physical disability at enrollment, and its extended long-term observational follow-up (ASPREE-XT). Long-term BPV was estimated in each participant using the standard deviation (SD) of the means of three within-visit systolic BPs obtained using a validated automated oscillometric BP monitor from the baseline and first two annual ASPREE visits. During ASPREE and continued into ASPREE-XT, participants underwent annual/biennial measures of grip strength using a Jamar hand grip dynamometer, and completed a timed 3 meter walk at normal pace. Linear mixed models were used to examine changes in gait speed and grip strength trajectories over a median of 5.2 years of follow-up after the second annual ASPREE visit (end of BPV estimation window). After covariate adjustment, the highest SD tertile of BPV, compared to the lowest SD tertile, was associated with greater declines in gait speed over time, and reduced grip strength cross-sectionally (see accompanying Table). Our findings suggest that long-term BPV is an important predictor of progressive loss of physical performance, particularly gait speed, in older adults. Since BP is routinely measured in practice, characterization of the visit-to-visit BPV may help identify older adults at risk of future declines in physical function and loss of independence.