Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Jan 27:2021:2690296.
doi: 10.1155/2021/2690296. eCollection 2021.

Association between Frailty and Mortality, Falls, and Hospitalization among Patients with Hypertension: A Systematic Review and Meta-Analysis

Kaiyan Hu  1 , Qi Zhou  2 , Yanbiao Jiang  3 , Zhizhong Shang  3 , Fan Mei  1 , Qianqian Gao  1 , Fei Chen  1 , Li Zhao  1 , Mengyao Jiang  1 , Bin Ma  1   4
Affiliations
Meta-Analysis

Association between Frailty and Mortality, Falls, and Hospitalization among Patients with Hypertension: A Systematic Review and Meta-Analysis

Kaiyan Hu et al. Biomed Res Int. .

Abstract

Objective: Chronological age alone does not adequately reflect the difference in health status of a patient with hypertension. Frailty is closely associated with biological age, and its assessment is clinically useful in addressing the heterogeneity of health status. The purpose of our study is to comprehensively examine the predictive value of frailty for negative health outcomes in hypertensive patients through a systematic review and meta-analysis.

Methods: Multiple English and Chinese databases were searched from inception to 04.11.2020. All cross-sectional and longitudinal studies that examined the association between frailty and relevant clinical outcomes among hypertensive patients were included. The NOS was used to assess the risk of bias of studies included in the analysis. Hazard ratios (HRs), odds ratios (ORs), and 95% confidence intervals (CIs) were pooled for outcomes associated with frailty.

Results: Six longitudinal studies and one cross-sectional study involving 17403 patients with hypertension were included in the meta-analysis. The risk of bias of all included studies was rated as low or moderate. The pooled HR of frailty related to mortality was 2.45 (95% CI: 2.08-2.88). The pooled HR of prefrailty and frailty-related injurious falls was 1.07 (95% CI: 0.83-1.37) and 1.89 (95% CI: 1.56-2.27), respectively. The pooled HR of prefrailty and frailty-related hospitalization was 1.54 (95% CI: 1.38-1.71) and 1.94 (95% CI: 1.17-3.24), respectively.

Conclusions: This systematic review suggests that frailty was a strong predictor of mortality, hospitalization, and injurious falls among patients with hypertension. Our findings indicate that assessment of frailty in patients with hypertension to guide their management may be necessary in clinical setting. However, our finding was based on very limited amount studies; thus, future studies are required to further validate the role of frailty in prediction of negative health outcomes in hypertensive patients as well as pay more attention to the following knowledge gaps: (1) the association between frailty and hypertension-related outcomes, (2) the significance of the association between different frailty models and relevant clinical outcomes, and (3) the predictive value of prefrailty for the negative health outcomes in people with hypertension.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Flowchart describing the selection of studies.
Figure 2
Figure 2
Forest plot of the association between frailty and all-cause mortality. Vaes-a 2017 describes a subsample of hypertension diagnosed by SBP of 140-160 mmHg; Vaes-b 2017 describes a subsample in which hypertension was diagnosed by SBP ≥ 160 mmHg.
Figure 3
Figure 3
Forest plot of the association between frailty or prefrailty and all-cause hospitalization.
Figure 4
Figure 4
Forest plot of the association between frailty or prefrailty and injurious falls.
Figure 5
Figure 5
Forest plot of the association between frailty and kidney damage (presence of proteinuria) among hypertensive patients.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Lloyd-Jones D. M., Evans J. C., Levy D. Hypertension in adults across the age spectrum. JAMA. 2005;294(4):466–472. doi: 10.1001/jama.294.4.466. - DOI - PubMed
    1. World Health Organization. A global brief on hypertension: silent killer, global public health crisis. Geneva, Switzerland: 2013. (World Health Day 2013 Report).
    1. Vasan R. S., Larson M. G., Leip E. P., et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. New England Journal of Medicine. 2001;345(18):1291–1297. doi: 10.1056/NEJMoa003417. - DOI - PubMed
    1. Beckett N. S., Peters R., Fletcher A. E., et al. Treatment of hypertension in patients 80 years of age or older. New England Journal of Medicine. 2008;358(18):1887–1898. doi: 10.1056/NEJMoa0801369. - DOI - PubMed
    1. Beckett N., Peters R., Tuomilehto J., et al. Immediate and late benefits of treating very elderly people with hypertension: results from active treatment extension to Hypertension in the Very Elderly randomised controlled trial. BMJ. 2012;344:d7541–d7541. - PubMed

LinkOut - more resources