Background

Aging is associated with progressive loss of muscle strength. Muscle tissue is vascularized by an elaborate vascular network. There is evidence that claret pressure (BP) is associated with musculus function in middle age. It is unknown how BP associates with muscle function in oldest old people. Nosotros studied the association between BP and handgrip strength in middle and quondam age.

Methods

BP was measured automatically in middle-aged subjects and with a mercury sphygmomanometer in the oldest old. Handgrip strength was measured with a handgrip strength dynamometer. Crosssectional measurements of handgrip strength and BP were bachelor for 670 heart-aged subjects (hateful 63.2 ± 6.vi years) and 550 oldest old subjects (all 85 years). Prospective data were bachelor for oldest old subjects only with a 4-yr follow-upwardly at 89 years. The association between BP and handgrip strength was analyzed past linear regression analysis.

Results

In middle-aged subjects, BP and handgrip strength were not statistically significantly associated. In oldest old subjects, higher systolic BP (SBP), mean arterial pressure level (MAP), and pulse pressure level (PP) were associated with college handgrip strength after adjusting for comorbidity and medication use (all P < 0.02). Furthermore, in oldest old subjects, changes in SBP, MAP, and PP after 4 years was associated with declining handgrip strength (all, P < 0.05).

Determination

In oldest old, higher BP is associated with better muscle strength. Farther written report is necessary to investigate whether BP is a potential modifiable run a risk cistron for prevention of age-associated decline in muscle force.

American Journal of Hypertension, advance online publication 2 September 2010; doi:10.1038/ajh.2010.185

Introduction

Aging is associated with a pass up in musculus mass, commonly referred to equally sarcopenia. one, –iii Sarcopenia is a major determinant of force loss in the elderly. Poor muscular strength is in turn associated with agin outcomes, such every bit physical disability and mortality. four,five Depending on the definition used, the prevalence of sarcopenia is reported to be as high as 60% in the full general oldest one-time population (over 85 years). 1 By 2050, the oldest sometime will account for i-fifth of all older persons globally. 6 In view of the detrimental effects sarcopenia may have on the quality of life and survival of our crumbling societies, research into its pathogenesis and etiology is mandatory for optimization of preventive and therapeutic strategies.

Skeletal musculus tissue is vascularized by an elaborate microvascular network of arterioles and venules and makes upwardly 30–40% of body mass. During strenuous exercise, skeletal claret flow is regulated past increasing cardiac output and reducing vascular resistance in the feeding arteries and arterioles of skeletal muscle. 7, –9 Crumbling has been associated with a reduced activity tolerance attributed to changes in this skeletal muscle blood flow. 10, , –13 Blood pressure (BP) is a biomarker of atherosclerosis and might exist associated with skeletal muscle tissue impairment, comparable to kidney failure and dementia. vii,14, , –17

A normally used proxy for global musculus strength is handgrip force. 18,19 Isometric handgrip forcefulness exercise has been associated with lower resting diastolic BP (DBP). 20 This finding shows that resistance grooming limited to the hand only is associated with changes in systemic BP. Furthermore, lower handgrip forcefulness was associated with higher resting BP in a large population-based sample of men and women (mean age 66 years). 21 Torso composition measures such as higher body mass index (BMI) and waist circumference, associated with lower lean trunk mass, have been associated with higher BP in middle-anile volunteers. 22

In dissimilarity to immature and middle-aged subjects, recent studies in oldest old subjects have shown that college BP is associated with preservation of renal role 23 and amend noesis. 24, –26 Hence, these are major health conditions that significantly depend on vascular role. Possibly the association between BP and handgrip forcefulness besides changes in dissimilar historic period groups similar to our findings for cerebral function. 24

Nosotros investigated the hypothesis that college BP is associated with lower handgrip strength in middle historic period and that in oldest onetime higher BP is associated with college handgrip strength. We studied the clan betwixt BP and handgrip force, every bit a proxy of muscle strength, in 2 contained populations of different ages, i.due east. middle-aged and oldest sometime subjects.

Method

Subjects. In the Leiden Longevity Written report, 420 families were recruited consisting of long-lived Caucasian siblings together with their middle-aged offspring and the partners thereof. 27 At that place were no other inclusion criteria for the offspring, other than being offspring of the nonagenarian siblings or being the partner of the offspring for the group of partners. Our report includes the cross-sectional baseline sample of the center-aged offspring and their partners (due north = 670). All subjects visited the report center where all measurements were performed.

The Leiden 85-plus Study is a community-based longitudinal study of all inhabitants of the city of Leiden, the Netherlands. 28 Enrollment took place between 1997 and 1999. All inhabitants who reached the age of 85 years, including nursing domicile residents, were eligible to participate (n = 550). Subjects were visited at their place of residence where all measurements were performed. Annual follow-up visits were performed until expiry or age 90 years.

In both studies, there were no pick criteria on health or demographic characteristics. 29,30 The Medical Ethical Committee of the Leiden Academy Medical Middle canonical both studies. Informed consent was obtained from all subjects. In case of severe cognitive impairment, a guardian gave informed consent.

Blood force per unit area. In the Leiden Longevity Study, BP was measured at in one case signal. BP was measured twice in each participant at the first of the visit at the study center and twice once again iii h later at the stop of the visit. BP was measured using an automatic BP device, Omron 705CP (Omron, Matsusaka, Matsusaka City, Japan) in a seated position afterward at least 5min of rest and no vigorous exercise in the preceding 30min. For the analyses, we used the means of the 2d and 4th measured systolic BP (SBP) and DBP.

In the Leiden 85-plus Study, BP was measured one time at 2 fourth dimension points. BP was measured during the home visits. Subjects were visited twice, with a hateful intervening menstruation of 2 weeks, at ages 85 and 89 years. For the assay, we used the ways of the two measurements of SBP and DBP. BP was measured, using a mercury sphygmomanometer, in a seated position after at to the lowest degree 5min of rest and no vigorous exercise in the preceding 30min. The systolic value was measured at the kickoff Korotkoff sound, and the diastolic value was measured at the 5th Korotkoff audio. 23 Mean arterial pressure level (MAP), the steady component of BP, was calculated equally 1/3 (SBP) + 2/iii (DBP) in both studies. 29 Pulse pressure (PP), the pulsatile component of BP, was calculated every bit SBP − DBP in both studies. 29

Handgrip force. Handgrip strength was used every bit a proxy of musculus strength. 18,19 In both studies, handgrip strength was measured with a Jamar paw dynamometer (Sammons Preston, Bolingbrook, IL). Handgrip forcefulness and BP were measured on the same day in both studies. All subjects were asked to stand upwardly and hold the dynamometer in the ascendant hand with the arm parallel to the trunk without squeezing the arm against the body. The width of the handle was adjusted to the size of the hand to brand certain that the middle phalanx rested on the inner handle. The participant was allowed to perform one test trial. Later on this, iii trials followed and the best score was taken for assay. Handgrip strength was expressed in kilograms. In the Leiden Longevity Study, handgrip strength was measured at one time point. In the Leiden 85-plus Report, handgrip strength was measured at ages 85 and 89 years.

Potential confounders. Anthropometric data were collected for all subjects. BMI (weight/peakii) was computed for each field of study. Information on common chronic diseases and medication use was obtained from the full general practitioner, pharmacist'southward records, and blood sample analysis. Chronic diseases included diabetes mellitus, chronic obstructive pulmonary disease, rheumatoid arthritis and osteoarthrosis, malignancy, myocardial infarction, stroke, and hypertension.

Comorbidity was defined as a sum score of all chronic diseases per subject, excluding hypertension. A sum score for comorbidity might underestimate the impact of comorbidity on health status; therefore, the total number of prescription medications was also included. Smoking habits were recorded by self-report. Cognitive functioning was measured with the Mini Mental Country Examination. 30

Statistical analysis. The clan between comorbidity and handgrip force was analyzed by linear regression analysis, adapted for gender, acme and weight, and age for eye-aged subjects. The clan between BP and handgrip strength was analyzed past linear regression assay by using iv models. In model i, the assay was adjusted for gender, height, weight, and smoking. In middle-aged subjects, age was included in model one; in oldest old subjects knowledge (Mini Mental State Exam) was included in model 1. Model two was adjusted as model one with farther adjustments for number of chronic diseases, except cardiovascular disease and hypertension. Model 3 was adjusted as model two with farther adjustments for the cardiovascular diseases, except hypertension. Model four was adjusted as model iii with further adjustments for number of medication (including antihypertensive medication) as a proxy for the severity of chronic illness. For the prospective assay in the oldest old subjects, all models were additionally adapted for BP at baseline (BP85 + BP89/2). The association between tertiles of BP and handgrip strength was analyzed by linear regression assay adjusted for gender, height, weight, and when appropriate age.

To test whether antihypertensive medication influenced the clan betwixt BP and handgrip strength, BPs were divided into tertiles to grade groups with similar BPs. The departure in handgrip force between users and nonusers of antihypertensive medication was tested by linear regression. Information on class of medication were available for the oldest old subjects. The medication was divided into four classes; angiotensin-converting enzyme inhibitors, β-blockers, diuretics, and calcium antagonists. Mean values of handgrip forcefulness between classes of medication were assessed by analysis of variance.

In the oldest old subjects, BP at 85 years was ranked in tertiles. Cut points for SBP were: lowest 110–147mmHg, middle 148–162mmHg, highest 163–215mmHg. Cut points for DBP were: everyman 47–72mmHg, middle 73–81mmHg, highest 82–115mmHg. Cut points for MAP were: lowest 70–98mmHg, middle 98–107mmHg, highest 108–146mmHg. Cut points for PP were: everyman 45–71mmHg, middle 72–84mmHg, highest 84–131mmHg.

SPSS 17.0 for Windows was used for all analyses. P values < 0.05 were considered statistically significant.

Results

Subjects characteristics

Baseline characteristics of the study subjects are presented in Tabular array 1. Mean age of the heart-aged subjects was 63.2 ± half-dozen.6 years and mean historic period of the oldest former subjects was exactly 85 years.

Table one

Baseline characteristics of study subjects

Baseline characteristics of study subjects

Table ane

Baseline characteristics of report subjects

Baseline characteristics of study subjects

In center-aged subjects, higher BMI was associated with higher SBP and DBP (both, P < 0.001) and college handgrip forcefulness (P = 0.002). In oldest one-time subjects, BMI was not associated with BP (P > 0.100) and handgrip force (P = 0.102). Moreover, in middle-anile subjects comorbidity was significantly associated with lower handgrip strength (−one.0kg for each additional comorbidity, P = 0.04). In oldest old subjects, comorbidity was also associated with lower handgrip strength (−0.7kg for each additional comorbidity, P = 0.02). In both cohorts, no differences were constitute in hateful handgrip strength betwixt users and nonusers of antihypertensive medication within tertiles of BP (data not shown, all, P > 0.05).

BP and handgrip strength, cross-exclusive associations

The results for middle-aged subjects are presented in Table two. College mean DBP was associated with a higher handgrip strength (0.06kg higher per 1mmHg increase in pressure, model i and 4, P < 0.05). After adjustment for chronic diseases (model 2 and model 3), the observed significance was lost. No associations were institute betwixt hateful SBP, PP, MAP, and handgrip strength in centre-aged subjects. At that place were no differences betwixt offspring and partners in the association between BP and handgrip forcefulness (data not shown).

Tabular array ii

Claret pressure level equally determinant of handgrip strength in middle-aged subjects

Blood pressure as determinant of handgrip strength in middle-aged subjects

Table 2

Blood pressure as determinant of handgrip strength in eye-anile subjects

Blood pressure as determinant of handgrip strength in middle-aged subjects

In oldest former subjects, college mean SBP, MAP, and PP were all associated with higher handgrip strength ( Table 3). Later adjusting for chronic diseases (model 2 and 3), none of the observed associations inverse (all, P ≤ 0.01) in oldest quondam subjects. Further aligning for the number of medications did not change the results (model 4). DBP was not associated with handgrip forcefulness at 85 years after adjusting for chronic diseases and number of medication. At 89 years, no significant associations were found for DBP. There were no differences in mean handgrip strength dependent on grade of medication in the group of users and nonusers of antihypertensive medication (all, P > 0.100; information non shown). Figure 1 shows hateful handgrip strength according to tertile of BP in oldest old subjects. Higher mean BP is significantly associated with college mean handgrip forcefulness after adjusting for sex, height, weight, smoking, and Mini Mental State Examination (all, P for trend < 0.05).

Tabular array 3

Blood pressure level as determinant of handgrip forcefulness in oldest erstwhile subjects

Blood pressure as determinant of handgrip strength in oldest old subjects

Table 3

Claret force per unit area as determinant of handgrip strength in oldest old subjects

Blood pressure as determinant of handgrip strength in oldest old subjects

Mean handgrip strength co-ordinate to tertile of resting blood force per unit area in oldest old subjects (85 years). SBP: lowest tertile 110–147mmHg, middle tertile 148–162mmHg, highest tertile 163–215mmHg. DBP: everyman tertile 47–72mmHg, middle tertile 73–81mmHg, highest tertile 82–115mmHg. MAP: everyman tertile 70–98mmHg, centre tertile 98–107mmHg, highest tertile 108–146mmHg. PP: lowest tertile 45–71mmHg, middle tertile 72–84mmHg, highest tertile 84–131mmHg. Mistake bars indicate s.e. P value indicates P for trend of mean handgrip strength in tertiles of blood pressure (adjusted linear regression analysis). DBP, diastolic blood pressure level; MAP, mean arterial pressure; PP, pulse force per unit area; SBP, systolic blood pressure.

Effigy 1.

Figure 1.

Figure 1.

Mean handgrip strength co-ordinate to tertile of resting claret pressure level in oldest one-time subjects (85 years). SBP: lowest tertile 110–147mmHg, eye tertile 148–162mmHg, highest tertile 163–215mmHg. DBP: lowest tertile 47–72mmHg, middle tertile 73–81mmHg, highest tertile 82–115mmHg. MAP: lowest tertile 70–98mmHg, middle tertile 98–107mmHg, highest tertile 108–146mmHg. PP: lowest tertile 45–71mmHg, middle tertile 72–84mmHg, highest tertile 84–131mmHg. Fault confined indicate s.e. P value indicates P for trend of mean handgrip strength in tertiles of blood pressure (adapted linear regression analysis). DBP, diastolic claret pressure; MAP, mean arterial pressure; PP, pulse pressure; SBP, systolic blood pressure.

Figure 1.

BP and handgrip strength during follow-up in oldest old subjects

At age 89 years, 196 (35.vi%) subjects had died and 33 (vi%) refused farther participation in the study. Mean SBP and DBP declined 5.8mmHg (due south.d. 17.9) and five.4mmHg (s.d. 8.8) respectively (both, P < 0.001) from ages 85 to 89 years. Over time the turn down of the MAP was 5.5mmHg (mean, south.d. ten.three, P < 0.001). PP did not significantly change during follow-upward. Handgrip force declined significantly from ages 85 to 89 years. In oldest sometime men, mean handgrip strength declined during follow-up with vi.3kg (s.d. 5.4, P < 0.001). In oldest former women, mean handgrip strength declined 3.4kg (s.d. four.2kg, P < 0.001) during follow-up.

Table 4 shows the association betwixt change in BP and change in handgrip strength from 85 to 89 years. During follow-up, declining SBP and MAP were associated with a higher decline in handgrip forcefulness (0.04 and 0.06kg pass up in handgrip strength per 1mmHg decline in SBP and MAP, respectively, both P ≤ 0.05). This means that per 10mmHg decline in SBP or MAP, handgrip strength declined 0.iv and 0.6kg, respectively. These results remained unchanged after adjusting for comorbidity (models ii and iii, all P < 0.05). Later on adjustment for number of medications, associations remained similar for pass up in SBP (model 4, P = 0.023), but were lost for reject in MAP (model 4, P = 0.058). Decline in PP was significantly associated with a college decline in handgrip strength after adjustment for all measured potential confounders (0.04kg decline in handgrip strength per 1mmHg turn down in PP, P = 0.049, model 4). No meaning association was observed for change in DBP and change in handgrip strength during follow-up.

Table 4

Association between alter in blood pressure and change in handgrip strength in oldest one-time subjects

Association between change in blood pressure and change in handgrip strength in oldest old subjects

Table 4

Clan betwixt modify in blood force per unit area and change in handgrip strength in oldest sometime subjects

Association between change in blood pressure and change in handgrip strength in oldest old subjects

Discussion

In our prospective population-based report of oldest old subjects, we found a positive association between SBP, DBP, and PP and handgrip strength in oldest old subjects. Furthermore, nosotros establish that declining SBP, MAP, and PP were associated with a decline in handgrip strength during follow-up. BP was not associated with handgrip force in the middle-aged subjects.

Nosotros hypothesized that higher BP was associated with lower handgrip strength in middle-aged subjects, considering college BP has been associated with lower handgrip force and body limerick in earlier cross-sectional studies. 21,22 However, our cross-sectional assay showed that in middle-aged subjects, lower handgrip forcefulness was not significantly associated with higher BP.

In the oldest old subjects, withal, higher BP was associated with higher handgrip strength. Furthermore, declines in SBP and MAP were associated with a subtract in handgrip strength in the oldest one-time during follow-up. Earlier we accept shown that higher BP was associated with better renal role 23 and cognition 24 over time in oldest old subjects of the Leiden 85-plus Written report. Euser et al. studied historic period-related differences in BP and changes in cognitive office. 24 Higher BP was a risk factor for cognitive pass up upwards to the age of 75 years, but surprisingly in oldest old subjects higher BP was associated with better cognitive function. Others have as well reported on the association of higher BP and improve cognitive role in very former age. 25,26

How can nosotros explicate the associations betwixt higher BP and better muscular function in the oldest old? Peripheral vascular resistance increases with chronological historic period due to a reduced sympatholysis, which results in an elevated sympathetic tone. 31,32 2d, morphological changes to the arteriolar network contribute to higher vascular resistance. 8 Third, aging is associated with a reduced capacity in vasodilation caused by changes in endothelium-dependent pathways in fauna models. 33, , –36 Perhaps increased vascular resistance during the aging process requires college pressure as a mechanism to maintain tissue perfusion as a means to prevent farther ischemic end organ damage in kidney, brain, and skeletal muscle. Another crusade for college BP in elderly could be the age-associated increase in cortisol levels. 37,38 Only as higher cortisol levels associate with lower handgrip strength, this does not explain our finding of higher handgrip strength. 38

Moreover, some other possible explanation could be that BP assembly with the age-associated loss of lean mass without the presence of a causal relationship. 2,three Show of such a mutual pathway was establish in middle-anile men for mid-thigh cantankerous-exclusive areas and brachial talocrural joint pulse wave velocity. 39

Considering the numerous factors that have been associated with sarcopenia it is also possible that another unknown factor explains the positive association between handgrip strength and BP. 1

This study has several strengths for studying the association between BP and handgrip strength. The Leiden 85-plus Study is a longitudinal population-based cohort report with extensive measures for health and performance without selection criteria on health or demographic characteristics. Therefore the results can exist generalized to the western population of oldest old. Furthermore, the longitudinal design of the Leiden 85-plus Study with repeated measurements of both BP and handgrip strength allowed united states to demonstrate the longitudinal clan betwixt the two parameters in the oldest old subjects. A weakness of this report is that only cross-sectional associations were bachelor in the Leiden Longevity Study for the present analysis, which makes causal inference hard. Also no straight measurements of muscle mass were bachelor.

Conclusion

This report found a relationship between iv-year changes in handgrip strength and resting SBP, DBP, and PP in oldest former people. To our knowledge, this is the first study to report on the prospective human relationship between BP and musculus strength in oldest quondam subjects. The results of the Hyvet written report forty provide bear witness that lowering BP is beneficial for prevention of cardiovascular disease and lowering bloodshed take chances in healthy elderly. In contrast, nosotros institute that college BP is positively associated with meliorate consequence in old age, such equally renal function, 23 cognition, 24 and now musculus strength. Farther enquiry is needed into the implications of hypertension and antihypertensive treatment in the full general population of oldest old.

This study was supported past an unrestricted grant from the Netherlands System of Scientific Research (ZonMw), the Ministry building of Health, Welfare and Sports, the Netherlands Genomics Initiative/Netherlands Organization for scientific research and the Netherlands Consortium for Good for you Crumbling (NGI/NWO; 05040202 and 050-060-810 NCHA) and the seventh framework programme MYOAGE (HEALTH-2007-2.iv.5-ten).

Disclosure:

The authors declared no disharmonize of interest.

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