Blood pressure, frailty status, and all-cause mortality in elderly hypertensives; The Nambu Cohort Study

Abstract

Antihypertensive therapy is pivotal for reducing cardiovascular events. The 2019 Guidelines for the Management of Hypertension set a target blood pressure (BP) of <140/90 mmHg for persons older than 75 years of age. Optimal BP levels for older persons with frailty, however, are controversial because evidence for the relationship between BP level and prognosis by frailty status is limited. Here, we evaluated the relationship between systolic BP and frailty status with all-cause mortality in ambulatory older hypertensive patients using data from the Nambu Cohort study. A total of 535 patients (age 78 [70–84] years, 51% men, 37% with frailty) were prospectively followed for a mean duration of 41 (34–43) months. During the follow-up period, 49 patients died. Mortality rates stratified by systolic BP and frailty status were lowest in patients with systolic BP < 140 mmHg and non-frailty, followed by those with systolic BP ≥ 140 mmHg and non-frailty. Patients with frailty had the highest mortality regardless of the BP level. The adjusted hazard ratios (95% confidence intervals) of each category for all-cause mortality were as follows: ≥140 mmHg/Non-frailty 3.19 (1.12–11.40), <140 mmHg/Frailty 4.72 (1.67–16.90), and ≥140 mmHg/Frailty 3.56 (1.16–13.40) compared with <140 mmHg/Non-frailty as a reference. These results indicated that frail patients have a poor prognosis regardless of their BP levels. Non-frail patients, however, with systolic BP levels <140 mmHg had a better prognosis. Frailty may be a marker to differentiate patients who are likely to gain benefit from antihypertensive medication among older hypertensives.

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

“…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 ].…”

Current issues in frailty and hypertension management

“…A meta-analysis of observational studies showed that the blood pressure less than 140 is associated with lower mortality in non-frail patients, but the association was not observed in frail patients with 1.02 of hazard ratio 14 . In 535 older hypertensive patients in a Japanese cohort study, mortality rates stratified by systolic BP and frailty status were the lowest in patients with systolic BP < 140 mmHg and non-frailty, followed by those with systolic BP ≥ 140 mmHg and non-frailty 15 . In contrast, patients with frailty had the highest mortality regardless of the BP level, suggesting that frail patients have a poor prognosis regardless of their BP levels 15 .…”

“…In 535 older hypertensive patients in a Japanese cohort study, mortality rates stratified by systolic BP and frailty status were the lowest in patients with systolic BP < 140 mmHg and non-frailty, followed by those with systolic BP ≥ 140 mmHg and non-frailty 15 . In contrast, patients with frailty had the highest mortality regardless of the BP level, suggesting that frail patients have a poor prognosis regardless of their BP levels 15 . A recent study showed the association between systolic BP and mortality in older adults with or without frailty determined by frailty index 16 .…”

Current topics of frailty in association with hypertension and other medical conditions

“…In the same cohort, patients were prospectively followed up for 41 months and the associations of mortality with frailty and BP were evaluated. Among 49 patients who died, mortality rates were lowest in those with systolic BP < 140 mmHg and non-frailty, and highest in those with systolic BP < 140 mmHg and frailty [ 10 ]. The results indicated that frail patients have a higher risk of all-cause mortality than non-frail patients, especially those with lower BP, suggesting that frailty should be taken into account during BP management.…”