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

Abstract

ObjectiveTo assess the association between blood pressure (BP) control and frailty among middle-aged and older populations with hypertension in China from 2013 to 2018.DesignProspective longitudinal study.SettingThis study analysed data from the China Health and Retirement Longitudinal Study, a nationally representative survey administered in 28 provinces of China.ParticipantsA total of 3254 participants diagnosed with hypertension previous to 2013 were taken into analysis. 1932 participants who were not frail in 2013 were enrolled to calculate relative risk.Outcome measuresThe frailty score was constructed following Rookwood’s Cumulative deficit frailty index, with a score >0.25 defined as frailty (outcome variable). The self-reported status of BP control (exposure variable) represented the general status of the participant’s BP level. A fixed-effects model was used to analyse the association between BP control and frailty. A Cox proportional hazard model was further used to further calculate the relative risk of frailty for different BP control levels.ResultsThe fixed-effects model showed that compared with well-controlled BP, poorly controlled BP exhibited a positive association with frailty score (β=0.015; 95% CI 0.011 to 0.019; p<0.001). The Cox proportional hazard model also revealed a higher risk of frailty in the poorly controlled group (HR=1.96; 95% CI 1.49 to 2.56; p<0.001). Based on subgroup analyses, poorly controlled BP was positively associated with frailty in respondents aged <60 years old (fix-effects model: β=0.015, p=0.021; Cox model: HR=2.25, p<0.001), but not significant among those aged ≥75 years old.ConclusionsWe provide new evidence of a negative association between BP control and frailty risk, but the findings differ among different age groups. Individualised strategies for BP management should be developed, especially for older hypertension patients.

Prevalence and correlates of frailty in older hypertensive outpatients according to different tools: the HYPER-FRAIL pilot study

“…No significant association of frailty with office, home and ambulatory BP was detected in this sample, suggesting that BP values probably show a weaker association with frailty in older hypertensive adults in comparison with other clinical variables. Indeed, some previous studies reported similar results, showing no cross-sectional association between BP and frailty status, particularly at advanced age [ 46 , 63 ]. However, it cannot be excluded that our findings might have been influenced by the limited sample size.…”

“…To date, few studies have analysed the prevalence of frailty in older patients with hypertension, providing highly variable proportions ranging from 3 to 68% according to the clinical setting and the adopted assessment tool [ 9 , 45 , 46 ]. In older adults participating in the HYVET and SPRINT studies, frailty status was identified using the FI and a left skewed distribution of scores was observed, with median values of 0.17 and 0.18, respectively [ 12 , 25 , 26 ].…”

“…A number of literature studies has evaluated the association between frailty and BP and conflicting results have been described [ 9 ]. Some authors reported a higher prevalence of hypertension and poor BP control in frail individuals, particularly on ABPM [ 8 , 46 , 64 ], while some others described an association between frailty and low BP [ 32 , 65 ]. Finally, some studies indicate a more complex, U-shaped association between frailty and BP, implying that frail older adults may present with both low and high BP values [ 8 , 66 ].…”

A study on the prevalence and related factors of frailty and pre-frailty in the older population with hypertension in China: A national cross-sectional study

“…A meta-analysis showed that systolic blood pressure greater than or less than 140 mmHg among frail people did not affect mortality, ordinary people with systolic blood pressure less than 140 mmHg are less likely to die ( 29 ). According to a newly published longitudinal study, those with poorly controlled blood pressure had a higher risk of becoming frail (HR = 1.96, 95% CI 1.49–2.56, p 0.001), and their frailty ratings were positively correlated with them (β = 0.015; 95% CI 0.011–0.019; p 0.001) ( 30 ). The 2019 Chinese Guideline for Hypertension in Older Persons, the European Society of Hypertension, the European Geriatric Medicine Society, and other organizations strongly underlined that frailty assessment is a crucial component of the proper therapy of hypertension in older adults.…”

Changes in blood pressure associated with frailty and sarcopenia in elderly outpatients with cardiometabolic diseases

“…8 The relationship between BP and frailty was previously reported to be dependent on the age of the study population, 9 and it was inconsistent in a meta-analysis of general populations. 10 Hypertension in a middle-aged population was associated with an increased risk of frailty, 11 but, subjects >75 years with BP <110/75 mmHg were at an increased risk of frailty, 12 and lower BP was associated with a higher risk of frailty. 13 Additionally, there was no significant relationship to progression to frailty from prefrailty in a general population.…”