Association of Long-Term Blood Pressure With Frailty Progression in Older Adults: A Prospective Cohort Study.

Abstract

Hypertension is associated with an increased risk of frailty; however, the role of cumulative blood pressure and blood pressure variability in frailty remains underexplored. This study aims to investigate the association between long-term blood pressure and the progression of frailty in older adults. This study analyzed data from the Chinese Longitudinal Healthy Longevity Survey. Cox regression and linear mixed-effects model were used to assess the association between long-term blood pressure and frailty. The longitudinal study included 3,758 participants. The highest quartiles of cumulative systolic blood pressure, cumulative diastolic blood pressure, systolic blood pressure variability, diastolic blood pressure variability, and pulse pressure variability were associated with an increased risk of frailty. Specifically, the HR (95% CI) for the highest quartiles compared to the lowest were 1.228 (1.067, 1.413) for cumulative systolic blood pressure, 1.201 (1.044, 1.382) for cumulative diastolic blood pressure, 1.220 (1.066, 1.396) for systolic blood pressure variability, 1.224 (1.099, 1.440) for diastolic blood pressure variability, and 1.250 (1.090, 1.432) for pulse pressure variability, cumulative blood pressure and blood pressure variability exhibited significant interactions with time in frailty index (FI) progression. The highest quartile of cumulative systolic blood pressure showed an annual frailty index increase of 0.018 compared to the lowest quartile, while cumulative diastolic blood pressure (β: 0.012), systolic blood pressure variability (β: 0.012), and pulse pressure variability (β: 0.014) were also associated with frailty index progression. Higher cumulative blood pressure and blood pressure variability are associated with an increased frailty index over time. In adults aged ≥65 years, cumulative blood pressure and blood pressure variability may serve as early indicators of frailty. These findings highlight the need for a stratified approach to frailty management that considers long-term blood pressure patterns in older adults.