SBP-Mortality Association Modified by Frailty

A German longitudinal study suggested that the association between systolic blood pressure (SBP) and all-cause mortality in older adults may be modified by frailty, with a tendency toward lower risk among those with SBP≥130 mm Hg in frail older adults. The study included 1170 participants (median age 73.9 years, 41.6% women), 53.8% with history of hypertension (median SBP, 144.0 mm Hg, median diastolic BP 78.0 mm Hg). During median follow-up of 8.1 years, 268 deaths were identified. There were 251 (21.5%, 114 deaths) frail participants (frailty index ≥0.2 based on the accumulation of deficits). The association between SBP and mortality was analyzed using Cox proportional hazards models adjusted for age, sex, education, smoking, alcohol consumption, sleep disturbance, diastolic BP, and antihypertensive medications. The association was modified by frailty. Among non-frail, a J-shaped association was found with hazard ratios of 4.01, 0.92 and 1.98 for SBP<110, 140–150, and ≥160 mm Hg, respectively. For frail older adults, a tendency toward lower risk among those with SBP≥130 mm Hg was observed. However, current evidence is insufficient to support different SBP treatment targets in older adults. Source: https://www.ahajournals.org/