LARGE DIVERGENCES IN TARGET GROUPS OF ESH 2023 BP-LOWERING STRATEGIES IN OLDEST-OLD PATIENTS ACCORDING TO THEIR FUNCTIONAL AND/OR FRAILTY STATUS

Abstract

Objective: Treatment individualization is part of good clinical practice. Part of it is medication de-escalation in older adults with limited life expectancy or advanced frailty syndrome. The 2023 ESH guidelines for treatment of hypertension, for the first time made provision for tailored medication use based on functionality and age of the patient. We aimed to assess whether the 2023 ESH Guidelines strategy for antihypertensive treatment individualization aligns with the widely adopted treatment strategy based solely on frailty status. Design and method: We used data from a cross-sectional, nationwide survey of health determinants in non-institutionalized older persons in Poland that was conducted from 2018 to 2019 (PolSenior2). For the current analysis, we extracted data for hypertensive persons aged 80 years and older. Based on Fried criteria we categorized participants into fit, pre-frail, and frail. The Mini-Mental State Examination was used to screen for cognitive impairment, and the basic Activities of Daily Living for functional screening. We also checked the classification-assignment based on the ESH 2023 functional categorization (fit, slowed but autonomous for most activities, severely dependent) that is proposed for assessment of eligibility to tailored antihypertensive treatment. We then checked the concordance between the classifications. Results: The mean (SD) age of 1458 participants (52% women) was 86.0 (4.7). According to Fried’s definition, 47.9% were pre-frail and 46.4% frail, respectively. Based on the ESH 2023 approach, 10.3% of participants were classified as severely dependent who required treatment individualization and prioritization (91.3% of them frail) and 66.3% as fit who should be treated as usual (59.2% of them pre-frail and 33.1% frail, according to Fried’s frailty criteria). We found the correlation between the two classifications to be low (Spearman’s r=0.39, p<0.05) with the kappa coefficient of 0.11 (p<0.05). Conclusions: In the community-dwelling hypertensives, aged 80+ years, who are candidates for individualized antihypertensive therapy, there was discrepancy between frailty status and the ESH 2023 functional criteria for antihypertensive treatment individualization. A thoughtful approach should be taken to standardize the methodological concepts and fine-tune them according to specific clinical needs.