Management of blood pressure in patients with frailty: update and perspectives—a 2026 mini-review

Intensive blood pressure lowering reduces primary outcomes regardless of frailty status. Consideration of blood pressure targets is necessary in individuals with disabilities and reduced activities of daily living, because blood pressure tended to decline at the end of life in observational studies. Among older nursing home residents with frailty who were receiving treatment with antihypertensive agents and had a systolic blood pressure below 130 mm Hg, an antihypertensive treatment step-down strategy did not lead to statistically lower all-cause mortality than usual care. The benefit of intensive blood pressure lowering in individuals with autonomic dysfunction has not been clarified, and blood pressure management is often challenging. Blood pressure measurements may be affected by frailty. Optimal blood pressure, rather than a fixed target blood pressure level, should be considered by balancing the reduction in cardiovascular events with the maintenance of quality of life in patients with disabilities and those near the end of life.