Hypertension Trajectories and Frailty Among Middle‐Aged and Older Chinese Adults: A CHARLS Cohort Study

AIM: To assess whether longitudinal hypertension trajectories are associated with later frailty among middle-aged and older Chinese adults. METHODS: We analysed 6770 participants from the China Health and Retirement Longitudinal Study (CHARLS) with complete data from waves 1 to 4 after excluding implausible body mass index values. Hypertension trajectories across waves 1 to 3 were classified as persistent no hypertension, incident/progressive hypertension, remission/fluctuation hypertension, or persistent hypertension. Frailty index (FI) at wave 4 was the outcome. Multivariable linear regression, restricted cubic spline analyses, sensitivity analyses, and exploratory mediation analyses were performed. RESULTS: Compared with persistent no hypertension, incident/progressive hypertension (β = 0.013, 95% CI: 0.006-0.020), remission/fluctuation hypertension (β = 0.009, 95% CI: 0.003-0.015), and persistent hypertension (β = 0.008, 95% CI: 0.002-0.014) were associated with higher FI. Baseline systolic and diastolic blood pressure were also positively associated with FI. Systolic blood pressure showed a nonlinear association. Sensitivity analyses were broadly consistent. Exploratory mediation analyses suggested that cystatin C and C-reactive protein partly mediated the persistent hypertension-FI association. CONCLUSIONS: Dynamic hypertension patterns and higher baseline blood pressure were associated with greater subsequent frailty burden.