Association between blood pressure variability and frailty in older people with hypertension

Introduction Frailty is a common condition in older hypertensive adults with and is associated with increased risk of adverse outcomes. Blood pressure variability (BPV) is as an independent cardiovascular risk factor, but its relationship with frailty remains poorly understood, especially in outpatients. Objective To investigate the association between short-term 24-hour BPV and frailty in a cohort of older hypertensive outpatients. Patients and methods In this cross-sectional study 184 hypertensive outpatients aged ≥75 years underwent frailty assessment using a 40-item Frailty accumulation Index derived from comprehensive geriatric assessment and 24-hour ambulatory blood pressure monitoring (ABPM). Participants were categorized as non-frail, pre-frail, or frail, and short-term BPV was quantified using multiple indices. Multiple regression analysis was performed to identify associations between BPV and frailty status and adjusted β estimates were reported. Results Among participants (mean age 81.8 years, 68% women), 34.2% were non-frail, 42.9% pre-frail, and 22.8% frail. Frailty was directly correlated with nocturnal diastolic BPV. In adjusted analyses, nocturnal diastolic blood pressure (BP) SD was significantly associated with frailty (β = 0.076 P = 0.04), moreover systolic dipping showed a significant negative association with the frailty index (β = -0.17 P = 0.04) Conclusions Nocturnal but not diurnal BPV is associated with frailty in older hypertensive outpatients. These findings support the potential clinical value of BPV in geriatric care as a non-invasive marker of physiological vulnerability, easy to obtain whenever ABPM is required for hypertension management. Further studies are needed to clarify causality and define the potential of BPV assessment and modulation in older patients.