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Functional vulnerability beyond blood pressure: Intrinsic capacity impairment and cardiovascular risk stratification

Zhengqiu Zhang1, Qiang Tu2, Wanting Chen3

  • 1School of Physical Education and Sports, Soochow University, China.

Maturitas
|August 18, 2026
PubMed

Insights

Intrinsic capacity (IC) impairment and hypertension independently and jointly increase cardiovascular disease (CVD) risk. Combining IC assessment with hypertension status improves CVD risk prediction in older adults.

Area of Science:

  • Gerontology
  • Cardiovascular Medicine
  • Public Health

Background:

  • Intrinsic capacity (IC) reflects functional reserve but its role with hypertension in cardiovascular disease (CVD) risk stratification is unclear.
  • Assessing the combined impact of IC impairment and hypertension on incident CVD is crucial for aging populations.

Purpose of the Study:

  • To investigate the independent and combined associations of IC impairment and hypertension with incident CVD.
  • To explore the contribution of specific IC domains to CVD risk.
  • To evaluate the incremental value of integrating IC and hypertension status for CVD risk prediction.

Main Methods:

  • Pooled data from three prospective aging cohorts (China, England, US) involving 13,807 participants.
  • IC assessed across five domains: cognition, locomotion, vitality, psychological, and sensory function.
  • Cox proportional hazards models used to estimate CVD risk; Harrell's C-index assessed model discrimination.

Main Results:

  • Impaired IC alone (HR 1.53) and hypertension alone (HR 1.68) increased CVD risk compared to intact IC and no hypertension.
  • Coexisting impaired IC and hypertension conferred the highest CVD risk (HR 2.29).
  • Risk increased with more impaired IC domains; locomotion, psychological, and sensory domains were key contributors. Model discrimination improved (C-index 0.619 to 0.649).

Conclusions:

  • Intrinsic capacity impairment and hypertension are independent and joint predictors of incident CVD.
  • Integrating multidimensional functional assessment with hypertension status enhances cardiovascular risk stratification in aging populations.
Abstract

Keywords:
AgingCardiovascular diseaseFunctional reserveHypertensionIntrinsic capacity

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