Prevalence and correlates of frailty in older hypertensive outpatients according to different tools: the HYPER-FRAIL pilot study

Abstract

Objectives: To date, few studies have investigated frailty in hypertensive individuals. This study aimed at identifying the prevalence of frailty in a sample of hypertensive older outpatients using six different identification tools. Clinical correlates of frailty and agreement between different frailty definitions were also investigated.

Methods: The HYPER-FRAIL pilot study recruited hypertensive patients aged at least 75 years from two geriatric outpatient clinics of Careggi Hospital, Florence, Italy. Four frailty scales [Fried Frailty Phenotype, Frailty Index, Clinical Frailty Scale (CFS), Frailty Postal Score] and two physical performance tests [Short Physical Performance Battery (SPPB) and usual gait speed] were applied. The Cohen's kappa coefficient was calculated to assess agreement between measures. Multiple logistic regression was used to identify clinical features independently associated with frailty.

Results: Among 121 participants (mean age 81, 60% women), frailty prevalence varied between 33 and 50% according to the tool used. Moderate agreement was observed between Fried Frailty Phenotype, Frailty Index and SPPB, and between Frailty Index and CFS. Agreement was minimal or weak between the remaining measures (K < 0.60). Use of walking aids and depressive symptoms were independently associated with frailty, regardless of the definition used. Frailty correlates also included dementia, disability and comorbidity burden, but not office and 24-h blood pressure values.

Conclusion: Frailty is highly prevalent among older hypertensive outpatients, but agreement between different frailty tools was moderate-to-weak. Longitudinal studies are needed to assess the prognostic role of different frailty tools and their clinical utility in the choice of antihypertensive treatment.

Graphical abstract

FIGURE 1

Prevalence of frailty according to different definitions: overall (a) and sex-specific prevalence proportions (b). Frailty Postal Score: P = 0.015; gait velocity: P = 0.008; Short Physical Performance Battery (SPPB): P = 0.022; Frailty Index: P = 0.005; Fried Frailty Phenotype: P = 0.006; Clinical Frailty Scale: P = 0.002.

FIGURE 2

Venn diagram showing the overlaps between each frailty classification. The number of participants identified by each combination of instruments is shown by the number in each overlapping section. CFS, Clinical Frailty Scale; FFP, Fried Frailty Phenotype; FPS, Frailty Postal Score.