Frailty (HR 1.50; 95% CI 1.40-1.70; p<0.01), but not baseline systolic blood pressure, independently predicted long-term mortality in community-dwelling adults aged >=80 years.
Cohort (n=244)
No
Does frailty or baseline systolic blood pressure predict long-term mortality in community-dwelling octogenarians?
In community-dwelling octogenarians, frailty status, but not baseline systolic blood pressure, strongly predicts long-term mortality, suggesting frailty should guide risk stratification in advanced age.
Hazard Ratio: 1.5 (95% CI 1.4–1.7)
p-value: p=<0.01
Objective: Recent ESC and AHA/ACC hypertension guidelines recommend lower blood pressure (BP) treatment thresholds and targets in older adults, with the ESC redefining “very old age” as >=85 years. Whether baseline BP independently predicts long-term mortality in very old, community-dwelling individuals remains uncertain. We examined the relative prognostic impact of frailty and blood pressure on long-term mortality in octogenarians. Design and method: In 2013, as part of ongoing prospective cardiovascular risk surveillance program, we assessed all outpatient residents aged >=80 years under the care of NZOZ Eskulap in the town of Gniewkowo, Poland, representing 60% outpatient residents in that age group. Blood pressure was measured, medical history obtained, and a standardized physical examination including cognitive assessment, was performed. Home visits were conducted for participants unable to attend the clinic. Clinical Frailty Scale (CFS) scores were retrospectively assigned based on baseline data. Total mortality was ascertained over a 12-year follow-up. Results: The cohort comprised 244 participants (70.0% women) with a mean (SD) age of 83.9 (4.2) years; 86.0% had a prior diagnosis of hypertension. Mean CFS was 2.7 (1.8), and mean MoCA score was 16.5 (6.6). Over follow-up (mean duration 6.2 years), 87% of participants died. Kaplan–Meier survival curves stratified by frailty (CFS =4) demonstrated clear separation, whereas survival curves stratified by systolic BP (=140 mm Hg) overlapped. Similar findings were observed when systolic BP was categorized as =160 mm Hg, with no meaningful separation of survival curves. In Cox proportional hazards models, frailty (HR 1.50, 95% CI 1.40–1.70), age (HR 1.05, 95% CI 1.01–1.09), and male sex (HR 2.70, 95% CI 1.90–3.70) were independently associated with mortality (all p<0.01), whereas systolic BP was not (HR 1.001, 95% CI 0.995–1.008; p=0.65). Conclusions: In this long-term follow-up of very old community-based outpatients, mortality was strongly determined by frailty status but not by baseline systolic blood pressure. These findings underscore the primacy of geriatric assessment in the management of older adults, suggesting that frailty-rather than BP level-should guide risk stratification and therapeutic decision-making in advanced age.
Derezinski et al. (2026) conducted a cohort in Octogenarians (n=244). Frailty vs. Lower frailty was evaluated on Total mortality (HR 1.50, 95% CI 1.40-1.70, p=<0.01). Frailty (HR 1.50; 95% CI 1.40-1.70; p<0.01), but not baseline systolic blood pressure, independently predicted long-term mortality in community-dwelling adults aged >=80 years.