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
. 2022;26(10):962-970.
doi: 10.1007/s12603-022-1850-4.

Systolic Blood Pressure and Mortality in Community-Dwelling Older Adults: The Role of Frailty

C L Chen  1 , A P Cai, Z Q Nie, Y Q Huang, Y Q Feng
Affiliations

Systolic Blood Pressure and Mortality in Community-Dwelling Older Adults: The Role of Frailty

C L Chen et al. J Nutr Health Aging. 2022.

Abstract

Objectives: To investigate whether frailty modifies the association of systolic blood pressure (SBP) with cardiovascular mortality and all-cause mortality in community-dwelling older adults.

Design: A prospective cohort study.

Setting: A population-based study of nationally representative older Chinese adults in a community setting.

Participants: This study included participants aged 65 years or older from the Chinese Longitudinal Healthy Longevity Survey 2002-2014 and followed up to 2018.

Measurements: Participants were divided into two groups according to a frailty index based on the accumulation of a 44-items deficits model. The association between SBP and mortality was analyzed using multivariable-adjusted Cox proportional hazards models.

Results: Among 18,503 participants included, the mean age was 87.2 years and the overall median follow-up time was 42.7 months. We identified 7808 (42.2%) frail participants (mean frailty index=0.33), in which 7533 (96.5%) died during the follow-up. Effect modification by frailty was detected (P for interaction=0.032). Among frail participants, a U-shaped association was found with hazard ratios of 1.16 (95% CI, 1.02-1.32) for SBP < 100 mmHg, and 1.11 (95% CI, 1.00-1.24) for SBP ≥ 150 mmHg compared with SBP 120-130 mmHg. For non-frail older adults, a tendency toward higher risk among those with SBP ≥ 130 mmHg was observed. The analyses towards cardiovascular mortality showed similar results.

Conclusion: Our results suggest the presence of effect modification by frailty indicating a possible negative effect for elevated SBP in non-frail older adults and a U-shaped relationship of SBP in frail older adults with respect to mortality even after adjusting for diastolic blood pressure.

Keywords: Systolic blood pressure; frailty; mortality; older adults.

PubMed Disclaimer

Conflict of interest statement

The authors declared no potential conflicts of interest.

Figures

Figure 1
Figure 1
Flow Chart of Study Participants
Figure 2
Figure 2
Splines for the Association Between Systolic Blood Pressure and All-cause Mortality Stratified by Frailty Status Models were adjusted for age, gender, marital status, education, residence, income, current smoking, drinking habits, body mass index, diastolic blood pressure, and cognitive impairment.
Figure 3
Figure 3
Splines for the Association Between Systolic Blood Pressure and Cardiovascular Mortality Stratified by Frailty Status Models were adjusted for age, gender, marital status, education, residence, income, current smoking, drinking habits, body mass index, diastolic blood pressure, and cognitive impairment.
See this image and copyright information in PMC

References

    1. NCD Risk Factor Collaboration NCD-RisC Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 191 million participants. Lancet. 2017;389:37–55. 10.1016/S0140-6736(16)31919-5 PubMed PMCID: 5220163. - DOI - PMC - PubMed
    1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:1269–1324. 10.1161/HYP.0000000000000066 PubMed PMID: 29133354. - DOI - PubMed
    1. Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358:1887–1898. 10.1056/NEJMoa0801369 PubMed PMID: 18378519. - DOI - PubMed
    1. Williamson JD, Supiano MA, Applegate WB, et al. Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial. Jama. 2016;315:2673–2682. 10.1001/jama.2016.7050 PubMed PMID: 27195814; PMCID 4988796. - DOI - PMC - PubMed
    1. Wright JT, Jr., Williamson JD, Whelton PK, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373:2103–2116. 10.1056/NEJMoa1511939 PubMed PMID: 26551272. - DOI - PMC - PubMed

Publication types

LinkOut - more resources