Frailty Index Progression Around Hypertension Diagnosis in 14 Countries

Hypertension and frailty frequently coexist in older adults. However, relationships between their trajectories are unclear. This study aims to examine whether frailty progressed differently between individuals with and without hypertension before and after diagnosis.

Data were drawn from 3 nationally representative cohorts across 14 countries, including 21 418 participants (mean baseline age 63.2±10.2 years) followed for 16 to 18 years. Individuals with hypertension at baseline were excluded. Hypertension was defined by self-reported physician diagnosis and antihypertensive medication use by self-report of taking any medication. Diagnosis timing was based on the first survey wave at which hypertension was reported. Coarsened exact matching matched participants who developed hypertension with those who did not. Piecewise linear mixed models estimated frailty trajectories before and after diagnosis.

Among 10 709 participants who developed hypertension (median diagnosis age 70 years), frailty index rescaled to a 0 to 100 scale (0-100) increased by 0.63 points/y (95% CI, 0.57-0.70) before diagnosis and 1.09 points/y (95% CI, 0.97-1.21) after diagnosis. During the 8 years preceding diagnosis, participants who developed hypertension experienced greater increases in frailty index rescaled to a 0 to 100 scale than matched controls without hypertension (difference, 2.69 [95% CI, 2.43-2.95]). The corresponding difference during the 8 years after diagnosis was 1.51 (95% CI, 1.01-2.01). Among individuals with hypertension, antihypertensive medication use was associated with a nonsignificant reduction in frailty progression after diagnosis. Findings remained robust after excluding participants with cardiovascular conditions.

Participants with hypertension experienced faster frailty progression before and after diagnosis. Studies using objective blood pressure measurement are needed to confirm this association.