Association between ambulatory blood pressure variability and frailty among older hypertensive patients

Abstract

Frailty is a multifactorial geriatric syndrome. The age-related cumulative decline across interrelated physiological systems and impaired homeostatic reserves results in the increased vulnerability to stressors, especially exposed to acute or chronic illness. 1,2 Accordingly, older adults with frailty are related to an increment risk for the adverse health outcomes, including falls, 1 institutionalization, 3 delirium, 4 disability, 5 and mortality. 6 It was estimated that the prevalence rate of frailty was 19.6% in China. 7 With advancing age, frailty progresses at a great rate, which poses a grave threat to public health.

Association between control status of blood pressure and frailty among middle-aged and older adults with hypertension in China: a longitudinal study

“…Hypertensive respondents constituted nearly Open access 30% of the sample, and it is of great significance to verify the association between their BP and frailty risk. Our results revealed that a higher risk of frailty was associated with poorly controlled BP among respondents with hypertension, consistent with studies of Zhu et al 8 and Woo et al, 10 which indicated the BP variability was risk factor associated with higher-order frailty status. Compared with those two studies, our study assessed the association of frailty risk with general control status of BP over a relative period, and further indicated that intensive control of BP could influence the trajectory of frailty according to both longitudinal and cohort analyses.…”

“…Poorly controlled BP can predict many advanced disease and adverse outcomes including cognitive decline, falls, morbidity (cardiovascular disease, strokes, heart failure and chronic kidney disease, etc) and so on. 8 36–38 This can partly explain the negative association between poor BP control and higher frailty risk, as frail older individuals accumulate more deficits and undergo more adverse events as age increases. However, the pathophysiological mechanisms between them are complex and not fully understood and need to be determined through more prospective studies.…”

“… 7 Frailty and hypertension often coexist, with intense and complex physiological connections between them. 8 For hypertensive patients, controlling status of blood pressure (BP) is one of the most essential indicators for their health management level. The decline in homoeostatic mechanisms among the frail individuals tend to be more physiologically dysregulated in achieving a stable BP control.…”

“… 10 A recent study from China evaluated the association between 24-hour ambulatory BP variability and frailty among older hypertensive patients, and indicated that the greater BP variability of systolic BP (SBP), particular the average real variability and the coefficient of variation, were independent risk factors associated with higher-order frailty status. 8 Woo et al 10 conducted a longitudinal cohort study on 1156 older community dwellers in Hong Kong, with repeated BP measured three times a week during 1 year, and the results also indicated that high BP variability increased the risk of frailty (OR: 1.57; 95% CI 1.05 to 2.37). More concretely, many studies explored the association between BP control of hypertensive patients and specific aspects of frailty, such as depression and anxiety, 11 12 brain function and cognition 13 and physical functions.…”

The effect of frailty on the 24‐hour blood pressure pattern in the very elderly

“… 13 , 14 , 15 , 16 Studies have indicated that older patients have higher nighttime systolic BP as well as a reduced dipping and we hypothesize that these findings might be influenced by frailty. 8 , 17 …”