Related Experiment Video
Updated: Oct 16, 2025
Measuring Frailty in HIV-infected Individuals. Identification of Frail Patients is the First Step to Amelioration and Reversal of Frailty
Published on: July 24, 2013
Blood pressure, frailty status, and all-cause mortality in elderly hypertensives; The Nambu Cohort Study
Taku Inoue1,2, Mitsuteru Matsuoka3, Tetsuji Shinjo4
1Cardiovascular Medicine, Tomishiro Central Hospital, Tomigusuku, Japan. imtak-ryk@umin.ac.jp.
Insights
Frailty significantly increases mortality risk in older hypertensive patients, irrespective of blood pressure. Achieving systolic blood pressure below 140 mmHg benefits non-frail individuals, suggesting frailty status may guide antihypertensive therapy decisions.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Clinical Epidemiology
Background:
- Antihypertensive therapy is crucial for reducing cardiovascular events.
- Current hypertension guidelines recommend a blood pressure target of <140/90 mmHg for individuals over 75.
- Optimal blood pressure targets for frail older adults remain controversial due to limited evidence.
Purpose of the Study:
- To investigate the relationship between systolic blood pressure, frailty status, and all-cause mortality in older hypertensive patients.
- To determine if frailty status can help identify older hypertensive patients who may benefit from antihypertensive medication.
Main Methods:
- Analysis of data from the Nambu Cohort study, prospectively following 535 ambulatory older hypertensive patients (mean age 78 years, 37% with frailty).
- Patients were followed for a mean duration of 41 months to record all-cause mortality.
- Systolic blood pressure and frailty status were assessed to determine their association with mortality risk.
Main Results:
- Patients with frailty exhibited the highest mortality rates, regardless of their blood pressure levels.
- Non-frail patients with systolic blood pressure <140 mmHg had the lowest mortality rates.
- Adjusted hazard ratios indicated significantly higher mortality for frail patients and non-frail patients with systolic blood pressure ≥140 mmHg compared to non-frail patients with <140 mmHg.
Conclusions:
- Frailty is a strong independent predictor of poor prognosis in older hypertensive patients.
- Systolic blood pressure <140 mmHg is associated with a better prognosis in non-frail older adults.
- Frailty status may serve as a valuable clinical marker for tailoring antihypertensive treatment strategies in the elderly.
Abstract:
Antihypertensive therapy is pivotal for reducing cardiovascular events. The 2019 Guidelines for the Management of Hypertension set a target blood pressure (BP) of <140/90 mmHg for persons older than 75 years of age. Optimal BP levels for older persons with frailty, however, are controversial because evidence for the relationship between BP level and prognosis by frailty status is limited. Here, we evaluated the relationship between systolic BP and frailty status with all-cause mortality in ambulatory older hypertensive patients using data from the Nambu Cohort study. A total of 535 patients (age 78 [70-84] years, 51% men, 37% with frailty) were prospectively followed for a mean duration of 41 (34-43) months. During the follow-up period, 49 patients died. Mortality rates stratified by systolic BP and frailty status were lowest in patients with systolic BP < 140 mmHg and non-frailty, followed by those with systolic BP ≥ 140 mmHg and non-frailty. Patients with frailty had the highest mortality regardless of the BP level. The adjusted hazard ratios (95% confidence intervals) of each category for all-cause mortality were as follows: ≥140 mmHg/Non-frailty 3.19 (1.12-11.40), <140 mmHg/Frailty 4.72 (1.67-16.90), and ≥140 mmHg/Frailty 3.56 (1.16-13.40) compared with <140 mmHg/Non-frailty as a reference. These results indicated that frail patients have a poor prognosis regardless of their BP levels. Non-frail patients, however, with systolic BP levels <140 mmHg had a better prognosis. Frailty may be a marker to differentiate patients who are likely to gain benefit from antihypertensive medication among older hypertensives.
More Related Videos
04:00Author Spotlight: Assessing Surgical Frailty with Point-of-Care Ultrasound of Quadriceps Muscles
Published on: July 26, 2024
05:16Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
Published on: June 10, 2025
Related Concept Videos
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
01:27Pharmacodynamics in Geriatric Patients: Effects of Age
01:28Factors affecting Blood pressure
Physiological Factors:
01:15Drug Dosing: Geriatric Patients
01:30Hypertension III: Clinical Manifestations and Diagnostic Studies
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.