Background: High blood pressure in mid-life was associated with frailty in elderly patients; however, frail patients have reduced quality of life (QOL) causing blood pressure decline. We thought to evaluated relationship between the blood pressure and frailty. Methods: We registered 691 elderly patients who had any cardiometabolic risk factors (hypertension, diabetes, dyslipidemia, atrial fibrillation, and heart failure) between Sep. 2015 and April 2022, and follow up for 1 year (N = 363). Clinic blood pressure (CBP) was taken twice in a seated position, using semi-automatic upper arm device, without doctors or nurses present. Frailty was evaluated using modified Japanese Cardiovascular Health Study score (J-CHS) that included appendicular skeletal muscle index, hand grip strength, and walk speed, and Kihon check list (KCL) that included QOL associated with frailty. Results: Mean age was 79.2 ± 6.3 years (male 35.6%). There were 30.4 % of patients with frailty by J-CHS criteria and 38.0 % by KCL criteria. In the multivariate-adjusted logistic regression analysis, frailty by J-CHS criteria was significantly associated with lower clinic DBP (OR = 0.901 per 5 mmHg increase, 95%CI, 0.829–0.978, P = 0.013); frailty by KCL criteria was with lower clinic SBP (OR = 0.843 per 10 mmHg increase, 95%CI 0.761–0.933, P = 0.001). In patients with antihypertensive medication, frailty with KCL was associated with clinic SBP (OR = 0.815 per 10 mmHg increase, 95%CI 0.703–0.944, P = 0.006). In frail patients by J-CHS criteria at baseline, low clinic DBP at baseline (OR = 0.937 per 1 mmHg increase, 95%CI 0.883–0.994, P = 0.031) and change in clinic DBP (OR = 0.921 per 1 mmHg change, 95%CI 0.861–0.986, P = 0.018) were associated with sustained frailty at 1 year later. In patients with preserved walk speed (> 1.0m/sec) at baseline, change in clinic DBP was associated with development of reduced walk speed (< 1.0m/s) at 1 year later (OR = 0.945, 95%CI 0.893–0.999, P = 0.046). Conclusion: Frailty was associated with lower clinic systolic or diastolic blood pressure, and change in clinic DBP in elderly patients with cardiometabolic risk factors.