Original article Functional impairment as defined by the

World Health Organization (WHO) encompasses difficulty, disability, or dependency for activities of daily living (ADL).1 Functional impairment has an estimated prevalence of 10%–30 % in community-dwelling older adults worldwide and is one of the principal reasons for transition from the home to long-term nursing home care.2 Preservation of functional independence is identified by older people as one of the most important domains in the construct of successful aging, with some prioritizing it over prevention of major vascular events or even death.3 It is increasingly recognized that patient-important outcome measures such as preservation of ADL in later life should be incorporated into clinical research, clinical practice, and healthcare policy.4,5 However, this may not be commonly reflected in outcome measures reported in major cardiovas-cular trials of predominantly older populations with estab-lished cardiovascular risk factors or diseases. Hypertension is responsible for a considerable propor-tion of the population-attributable risk for major vascular diseases, which can increase risk of functional decline, par-ticularly stroke.6–8 The association between hypertension and functional impairment may also be mediated through subclinical cardiovascular disease independent of major vas-cular events. Hypertension has a role in covert stroke, which can manifest as cognitive decline, gait instability, and frailty and lead to functional impairment.9–12 In addition, hyper-tension is a risk factor for developing chronic kidney dis-ease and may be a risk factor for sarcopenia, both of which are associated with functional impairment.13,14 The effect