Association between blood pressure variability and frailty in older people with hypertension

Frailty is a common condition in older hypertensive adults, and it is associated with an increased risk of adverse outcomes. Blood pressure variability (BPV) is an independent cardiovascular risk factor, but its relationship with frailty remains poorly understood, especially in outpatients.

We aimed to investigate the association between short‑term 24‑hour BPV and frailty in a cohort of older hypertensive outpatients.

In this cross‑sectional study, 184 hypertensive outpatients aged at least 75 years underwent frailty assessment using a 40‑item frailty accumulation index derived from comprehensive geriatric assessment and 24‑hour ambulatory BP monitoring (ABPM). The participants were categorized as nonfrail, prefrail, or frail, and short‑term BPV was quantified using multiple indices. Multiple regression analysis was used to identify associations between BPV and frailty status, and adjusted β estimates were reported.

Mean (SD) age of the participants was 81.76 (4.32) years, and 68% were women. Of the entire group, 63 patients (34.2%) were nonfrail, 79 (42.9%) prefrail, and 42 (22.8%) frail. Frailty directly correlated with nocturnal diastolic BPV. In adjusted analyses, nocturnal diastolic BP was strongly associated with frailty (β = 0.076; P = 0.04), and systolic dipping showed a marked negative association with the frailty index (β = -0.17; P = 0.04).

Nocturnal but not diurnal BPV is associated with frailty in older hypertensive outpatients. These findings support the potential clinical value of BPV in geriatric care as a noninvasive marker of physiological vulnerability, easy to obtain whenever ABPM is required for hypertension management. Further studies are needed to clarify causality and define the potential of BPV assessment and modulation in older patients.