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Am Fam Physician. 2003;68(9):1846-1847

Age-associated changes in blood pressure homeostasis exacerbated by hypertension have been associated with increased fall risk. Possible mechanisms for this adverse condition include the negative effect of transient blood pressure reductions or hypertension causing alterations in gait and balance control. Hausdorff and associates examined the gait and balance of older adults with hypertension compared with healthy control subjects.

Subjects 65 years or older were classified as hypertensive or normotensive based on history and use of antihypertensive medications. Balance and gait were evaluated in the 24 participants using the pull test, Tinneti’s performance-oriented assessment of mobility, a modified Timed Up and Go test, mean stride time over a two-minute walk, and a scaling index of gait. Poor performance on these tests is associated with increased fall risk among older adults.

Balance and gait were generally good among both groups, but certain measurements demonstrated significantly worse balance and gait performance among the hypertensive adults. Increased blood pressure, including elevated systolic supine and standing blood pressure, was associated with worse performance, while higher standing heart rates were associated with better performance. Among the hypertensive participants, there was no difference between those using one or two antihypertensive medications, but the Timed Up and Go times were significantly longer in those taking angiotensin-converting enzyme inhibitors.

The authors conclude that higher levels of systolic blood pressure were associated with worsened balance and gait measurements. These results confirm the potential negative impact of systolic hypertension beyond known risk of cardiovascular disease progression.

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Copyright © 2003 by the American Academy of Family Physicians.

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