Author Affiliations: Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (Drs Yano and Kario); and Department of Orthopaedics, Chikamorikai Medical Group, Kochi, Japan (Dr Inokuchi).
We read with great interest the report by Odden et al1 that walking speed is a marker of frailty, which could identify an increased risk of mortality in older persons with lower blood pressure (BP). Those authors showed that older persons who walked slowly might not be at risk for the adverse effects of high BP. However, for slower-walking older persons, caution is needed with regard to BP levels measured in out-of-office settings, since we recently demonstrated that slower walking speed in older hypertensive patients (n = 148; mean age, 75.5 years) was associated with high nocturnal (ie, sleep) BP or less nocturnal BP dipping (ie, nondipping), but not daytime or office BP.2 Because a high nocturnal BP level in the general population or in hypertensive patients is not only a marker of vulnerability or frailty in individuals with concurrent systematic abnormalities but also a direct contributor to the cardiovascular burden,3 it follows that a slow gait in older persons may indicate masked hypertension with poor outcomes.4
Yano Y, Inokuchi T, Kario K. Walking Speed Is a Useful Marker of Frailty in Older Persons. JAMA Intern Med. 2013;173(4):325-326. doi:10.1001/jamainternmed.2013.1629