Frailty and arterial hypertension: clinical practice issues

Frailty is a state of increased vulnerability to endo- and exogenous stress factors when the physiological reserve is decreased due to ageing. Frailty poses challenges for the management of arterial hypertension (HTN) and other chronic cardiovascular and non-cardiovascular diseases in older adultst. Although many Russian and international clinical guidelines on HTN frailty recommended to consider it in decision making process on antihypertensive therapy tactics, the optimal criteria and instruments are still uncertain. HTN is common in patients with frailty, but the direct impact of HTN on frailty development has not been fully established. Blood pressure (BP) control is important for reducing the risk of cardiovascular events and maintaining quality of life in patients with HTN and frailty. BP decreases in later life and in patients who are completely dependent in daily activity. Mortality in patients with frailty and low BP is higher than in patients with high BP, which raises the question of the optimal BP level in this vulnerable category of patients. Cognitive decline is one of the domains of frailty that is closely associated with loss of autonomy, self-care ability, and reduced quality of life. It remains controversial whether antihypertensive therapy has beneficial effects on cognition in very old patients.