October 15, 2021Hypertension ResearchOpen Access

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

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension in older adults (n=535). Intervention: Frailty with systolic blood pressure <140 mmHg vs. Non-frailty with systolic blood pressure <140 mmHg. Primary outcome: All-cause mortality (HR 4.72, 95% CI 1.67-16.90).

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Key result

Frail older hypertensive patients had a significantly higher risk of all-cause mortality regardless of blood pressure levels, with those having systolic blood pressure <140 mmHg and frailty showing a 4.72-fold higher risk (HR 4.72) compared to non-frail patients with systolic blood pressure <140 mmHg.

Why the study?

Optimal blood pressure targets for older persons with frailty remain controversial due to limited evidence regarding the relationship between blood pressure level and prognosis by frailty status.

Does frailty status modify the association between systolic blood pressure levels and all-cause mortality in older hypertensive patients?

Population

535 ambulatory older hypertensive patients

Comparison

Systolic blood pressure categories (<140 vs ≥140 mmHg) stratified by frailty status

Design

Prospective cohort study

Follow-up

Mean 41 (34-43) months

Authors

TITaku InoueOkinawa Churashima Foundation MMMitsuteru MatsuokaYokosuka Kyosai Hospital TSTetsuji ShinjoTomishiro Central Hospital

Discussion

Member takes

Implication

Supports frailty screening for prognosis in older hypertensives; leaves open optimal BP targets in this subgroup.

Study Design

Type

Cohort (n=535)

Multicenter

Yes

Structured PICO

Does frailty status modify the association between systolic blood pressure levels and all-cause mortality in older hypertensive patients?

Population

535 older ambulatory hypertensive patients (median age 78, 49% female) were prospectively followed for a mean of 41 months to evaluate the relationship between systolic blood pressure, frailty status, and all-cause mortality.

Exposure

Systolic blood pressure levels (<140 mmHg vs ≥140 mmHg) stratified by frailty status.

Comparator

Systolic blood pressure <140 mmHg and non-frailty (reference group).

Outcome

All-cause mortalityhard clinical

Main Result

Hazard Ratio: 4.72 (95% CI 1.67–16.9)

Absolute Event Rate: 5.63% vs 0.73%

Frailty status modifies the prognostic benefit of strict blood pressure control (<140 mmHg) in older hypertensive patients, with survival benefits observed only in non-frail individuals.

Limitations

Observational nature cannot rule out confounding factors and shows only association, not causation.
Patients were outpatients of a hospital or clinic with multiple comorbidities, limiting generalizability to the general population or nursing home residents.
Only calcium channel blockers, ACE inhibitors, and ARBs were evaluated as antihypertensive agents.
Blood pressure values were evaluated using only the initial office visit measurement, without considering follow-up values.
Patients were residents of a relatively limited area in the southern part of Okinawa, Japan.

Cite This Study

Inoue et al. (2021) conducted a cohort in Hypertension in older adults (n=535). Frailty with systolic blood pressure <140 mmHg vs. Non-frailty with systolic blood pressure <140 mmHg was evaluated on All-cause mortality (HR 4.72, 95% CI 1.67-16.90). Frail older hypertensive patients had a significantly higher risk of all-cause mortality regardless of blood pressure levels, with those having systolic blood pressure <140 mmHg and frailty showing a 4.72-fold higher risk (HR 4.72) compared to non-frail patients with systolic blood pressure <140 mmHg.

synapsesocial.com/papers/6a79c93b02ab7a73dd028df0 https://doi.org/10.1038/s41440-021-00769-0

Topics

Hypertension management

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

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

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

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider