THE ASSOCIATION BETWEEN BLOOD PRESSURE AND FRAILTY IN VERY ELDERLY PATIENTS (>90 YEARS)

Abstract

Objective: Frailty is a common geriatric syndrome characterized by increased risk of hospitalization and mortality. The aim of this study was to assess the association between hypertension (HTN) and frailty, and mortality in very elderly patients (>90 years). Design and method: This prospective study included 107 patients aged >90 years (mean age 94.3, 37% male) hospitalized at the Cardiology department, Military Medical Academy, Sofia between January 2016 and December 2018. Study protocol included demographics, blood pressure measurement, body mass index, frailty screening, number of comorbidities, medications, physical activity, and cognitive status. Patients were classified as nonfrail, prefrail, or frail based on the internationally validated FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale, PRISMA 7 questionnaire, Mini-Mental State Examination, gait speed, timed-up-and-go test. Participants were followed for 18 ± 6 months. Outcomes of interest were pharmacological treatment of HTN and one-year mortality. We used the Cox regression model to examine the association between frailty, mean systolic blood pressure (SBP) and outcomes of interest. Ordinal logistic regression was used to evaluate factors associated with frailty. Results: Prevalence of HTN and frailty was 77.2% and 44.8%, respectively. HTN was more prevalent in prefrail (22.5%) and frail (43%) groups than in the nonfrail one (11.7%) (p = 0.005). When compared to nonfrails, the frail patients had lower SBP ((104.3 ± 15.2) vs. (131.5 ± 23.6) mmHg, p = 0.002) and higher one-year mortality (19.2% vs. 39.1%, p < 0.001). Low SBP was associated with increased all-cause mortality and accelerated cognitive decline in all patients regardless of frailty, but the effect was more pronounced among those on antihypertensive therapy. (HR 1.39 per 10 mmHg decrease in SBP, 95% CI 1.25–1.46, p < 0.001). Mortality rates increased with frailty level with the highest values for SBP <110 mmHg. Conclusions: Frail very elderly patients have a substantially lower SBP compared to nonfrail ones. Lower SBP may be associated with higher frailty rates and all-cause mortality among patients hospitalized for cardiac problems.