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Hypertension Accelerates Gait Speed Slowing

By Jaimie Lazare

High blood pressure has been linked to the acceleration of gait speed slowing, which is an important prognostic indicator of function and survival in older adults.

From Parkinson’s disease to arthritis, many medical conditions cause elder patients’ shuffling gait or slowed walking. A new study shows that high blood pressure also contributes to the slowing of walking or gait speed.

Caterina Rosano, MD, MPH, an associate professor of epidemiology at the University of Pittsburgh’s Center for Aging and Population Research, published the findings of a longitudinal cohort study on hypertension and gait speed slowing in the Journal of the American Geriatrics Society. Rosano and her colleagues reported that hypertension slowed walking speed among well-functioning community-dwelling older adults. This association was significant in newly diagnosed patients with hypertension as well as in patients with a history of either controlled or uncontrolled high blood pressure.

Although it is unclear why high blood pressure may lead to gait speed slowing, the researchers of this study suggested that a condition called white matter hyperintensities (WMH) might explain the link between high blood pressure and a decline in gait speed.

“White matter hyperintensities are exactly that—bright white in appearance—on an imaging study. They are areas of the brain that we think result from vascular injury, and therefore are reading a brighter shade of white,” says Ted M. Johnson II, MD, MPH, a professor of medicine and epidemiology and director of the Emory Center for Health in Aging in Atlanta. “And the thought is that poor blood pressure control might end up resulting in various adverse outcomes, including gait slowing, cognitive impairment, and functional dependence.”

“It’s implied that the potential link between gait slowing and high blood pressure is through these white matter hyperintensities,” says Claire Henchcliffe, MD, DPhil, an associate professor of neurology at Weill Cornell Medical College and director of the Weill Cornell Parkinson’s Disease and Movement Disorder Institute in New York. The association between WMH with gait slowing, dementia, and frailty has been well described in studies. There are many studies trying to assess the clinical sequelae of these white matter hyperintensities. It seems that researchers are just starting to get to the WMH location in the brain and how it might relate to what can be seen clinically, Henchcliffe says.

Walking Speed as an Indicator

Johnson notes that studies demonstrate the importance of examining your older patients’ gait speed because it’s important for health screening, decisions about surgery, making assessments about chemotherapy, and whether a patient is likely to be hospitalized.

As people aged 65 and older are becoming the largest segment of our population, researchers recognize the growing need to evaluate gait speed in geriatrics as an indicator of health and longevity outcomes among patients. A study in particular, Johnson notes, was published earlier this year in The Journal of the American Medical Association by Stephanie Studenski, MD, a professor of medicine at the University of Pittsburgh, and her colleagues that “predicted survival based on age, sex, and gait speed was as accurate as predicted based on age, sex, use of mobility aids, and self-reported function or as age, sex, chronic conditions, smoking history, blood pressure, body mass index, and hospitalization.” (The study was previously discussed in an Aging Well  E-Exclusive and can be accessed here.)

Besides the health concerns due to hypertension and slow walking pace, quality of life becomes a concern. Johnson says it’s important to understand how patients are engaged with their families, in their places of worship, and in their communities because levels of engagement in various settings influence patients’ ability to survive and thrive socially.

Henchcliffe agrees that older patients’ gait speed is important, not just in terms of managing their everyday basic functions and performing chores at home, but also in their ability to socialize in environments outside the home. “We know that maintaining an active life not only physically but intellectually and socially is so important for long-term health in the older population,” she says.

Physicians as Gait Keepers

“A lot of [the practice of] medicine has been based upon first diagnosing a disease or condition and then treating it. This is a curative perspective,” Johnson says. “So this notion of gait speed—how fast you comfortably walk—is a piece of information called a functional measure. You’re measuring an integrated function that incorporates how patients stand, receive commands to walk, and walk a certain distance, [which] involves cardiovascular, neurologic, orthopedic, and other systems. Gait as a clinical measure that doctors might do in the office is becoming less of a foreign concept, but I would still say it’s a little bit of a novelty. So how and why to integrate it into an overall picture of health is really the interesting part of these studies coming out,” he says.

Henchcliffe notes that one important aspect of the study on high blood pressure accelerating gait speed slowing is that it suggests asking patients about their walking speed because it might be a marker of underlying brain health. She recommends asking a patient whether he or she is walking more slowly or asking a caregiver or spouse whether the patient is unable to keep up when walking.

“And assuming there’s time, also observe the gait, observe the walking, maybe even time it. But use that as a marker that if it’s impaired, there may be something else going on that’s underlying, and it might be buildup of white matter hyperintensities, which then are very significant because we know those are related to dementia, stroke risk, and other problems,” Henchcliffe says.

While this new study demonstrates that hypertension may be linked to gait speed slowing, there are other health problems that should be evaluated, such as back pain, arthritis, cardiovascular or pulmonary problems, and medications, which can also inhibit gait speed. Physicians can readily identify the cause of gait slowing by evaluating whether it is affected by pain, a cardiac problem that creates shortness of breath, or dizziness due to medications. And for difficult-to-diagnose causes of gait speed slowing, it’s appropriate to refer the patient to a neurologist because such symptoms could indicate a problem in the brain, spinal cord, or peripheral nerves and specific interventions can help improve the long-term outcome in each case, Henchcliffe says.

Johnson says in his medical training physicians were taught that adding 100 to a patient’s age was an acceptable systolic blood pressure. “So if you’re 80, the thought would have been that an OK blood pressure would have been 180, which is clearly wrong based upon all the different articles to come forward since. It’s interesting how our knowledge and understanding changes and evolves, and I think that this is an important step in understanding what to do with gait speed,” he says. “Poor control of blood pressure ends up making people more likely to have their gait speed slowed, and that's a bad thing. So we have to do a better job of doing appropriate blood pressure management.”

— Jaimie Lazare is a freelance writer based in Brooklyn, N.Y.