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Yan J, Wu B, Lu B, Zhu Z, Di N, Yang C, Xu Q, Fan L, Hu Y. Association between baseline office blood pressure level and the incidence and development of long-term frailty in the community-dwelling very elderly with hypertension. Hypertens Res 2024; 47:1523-1532. [PMID: 38459173 DOI: 10.1038/s41440-024-01614-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/15/2024] [Accepted: 01/20/2024] [Indexed: 03/10/2024]
Abstract
Frailty is the most important risk factor causing disability in the elderly. Hypertension is one of the most common chronic diseases in the elderly and is closely related to frailty, but there is still controversy about the association between blood pressure and frailty. To explore the association between baseline blood pressure level and the incident and development of long-term frailty in the community-dwelling very elderly (i.e., over 80 years old [1]) with hypertension, in order to provide a basis for scientific blood pressure management of very elderly hypertension. In this study, very elderly hypertensive patients who received comprehensive geriatric assessment from January to June 2019 and with complete data were included, and follow-up was conducted from January 1 to February 14, 2023. A total of 330 very elderly individuals with hypertension were enrolled in this study. FRAIL scale was used to evaluate frailty. Binomial logistic regression analysis was used to calculate the OR and 95%CI between baseline systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP) levels and long-term incident and development of frailty. The dose-response relationship between baseline office SBP, DBP or PP levels and incident frailty and its development was analyzed by Generalized Additive Model (GAM) using smooth curve fitting and threshold effect analysis. Smooth curve fitting and threshold effect analysis showed that the relationship between baseline office SBP level and incident frailty was U-shaped, with the nadir of the U-shaped curve at 135 mmHg after adjustment. Baseline office SBP, PP level and development frailty was U-shaped and the nadir was 140 mmHg and 77 mmHg. In the community-dwelling very elderly with hypertension, baseline office SBP level had a relationship with long-term incident frailty and its development and PP level had a relationship with long-term development of frailty.
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Affiliation(s)
- Jin Yan
- Graduate School of Chinese PLA General Hospital & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China
| | - Bing Wu
- Graduate School of Chinese PLA General Hospital & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China
| | - Bingjie Lu
- Graduate School of Jilin Sport University, 130022, Changchun, China
| | - Zhihui Zhu
- Ningxia University, 750021, Yinchuan, China
| | - Ning Di
- Ningxia University, 750021, Yinchuan, China
| | - Cunmei Yang
- Geriatric Health Care Department 4th of The Second Medical Center, Chinese PLA General Hospital, 100853, Beijing, China
| | - Qiuli Xu
- Geriatric Health Care Department 4th of The Second Medical Center, Chinese PLA General Hospital, 100853, Beijing, China
| | - Li Fan
- Cardiovascular Department of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China.
| | - Yixin Hu
- Geriatric Health Care Department 4th of The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, 100853, Beijing, China.
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Yu BY, Hu XM, Matala R, Mo YH, Liu JL, Jin JG, Zhang SH, Ou YQ, Yang Y, Dong HJ. Association between trajectories of systolic blood pressure and frailty outcome in middle-aged and older adults. J Nutr Health Aging 2024; 28:100202. [PMID: 38460319 DOI: 10.1016/j.jnha.2024.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES The association between blood pressure and frailty outcome in the middle-aged and older population remains controversial. This study aimed to examine the relationship between trajectories of systolic blood pressure (SBP) and new-onset frailty. DESIGN Cohort study with a 7-year follow-up. SETTING AND PARTICIPANTS Data were derived from 4 waves (2011, 2013, 2015 and 2018) of the China Health and Retirement Longitudinal Study and 6168 participants aged ≥45 years were included in the study. METHODS The frailty index (FI) was constructed based on 40 scored items, with FI ≥ 0.25 defined as frailty. We identified the 5-year trajectory of SBP by latent class trajectory modeling. The association between SBP trajectories and frailty was explored based on hazard ratios (HR) by four Cox proportional hazards models. Furthermore, we also investigated the relationship between mean SBP and systolic blood pressure variability (SBPV) and frailty. RESULTS 6168 participants were included in this study with a mean age of 59 years. We identified five trajectories based on SBP, which are maintained low-stable SBP (T0), moderate-stable SBP (T1), remitting then increasing SBP (T2), increasing then remitting SBP (T3), and remaining stable at high SBP levels (T4). During the 7-year follow-up period, frailty outcome occurred in 1415 participants. After adjusting for other confounders, the two trajectories labeled "T2" and "T4" were associated with a higher risk of frailty compared with T0. In addition, elevated SBP and increased SBPV were associated with risk of frailty. CONCLUSIONS Higher risk of frailty occurred in two trajectories, remitting then increasing and remaining stable at high SBP levels, were associated with a relatively higher risk of frailty.
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Affiliation(s)
- B Y Yu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - X M Hu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - R Matala
- Department of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, One University Place, Rensselaer, NY, 12144
| | - Y H Mo
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - J L Liu
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - J G Jin
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - S H Zhang
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Y Q Ou
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Y Yang
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
| | - H J Dong
- Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Nyingchi People's Hospital, Nyingchi, 860000, Tibet, China.
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Tian G, Zhou R, Guo X, Li R. Causal effects of blood pressure and the risk of frailty: a bi-directional two-sample Mendelian randomization study. J Hum Hypertens 2024; 38:329-335. [PMID: 38361027 DOI: 10.1038/s41371-024-00901-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
Observational studies have indicated that high blood pressure (BP) may be a risk factor to frailty. However, the causal association between BP and frailty remains not well determined. The purpose of this bi-directional two-sample Mendelian randomization (MR) study was to investigate the causal relationship between BP and frailty. Independent single nucleotide polymorphisms (SNPs) strongly (P < 5E-08) associated with systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) were selected as instrumental variables. Two different published genome-wide association studies (GWAS) on BP from the CHARGE (n = 810,865) and ICBP (n = 757,601) consortia were included. Summary-level data on frailty index (FI) were obtained from the latest GWAS based on UK Biobank and Swedish TwinGene cohorts (n = 175,226). Inverse variance weighted (IVW) approach with other sensitivity analyses were used to calculate the causal estimate. Using the CHARGE dataset, genetic predisposition to increased SBP (β = 0.135, 95% CI = 0.093 to 0.176, P = 1.73E-10), DBP (β = 0.145, 95% CI = 0.104 to 0.186, P = 3.14E-12), and PP (β = 0.114, 95% CI = 0.070 to 0.157, p = 2.87E-07) contributed to a higher FI, which was validated in the ICBP dataset. There was no significant causal effect of FI on SBP, DBP, and PP. Similar results were obtained from different MR methods, indicating good stability. There was potential heterogeneity detected by Cochran's Q test, but no horizontal pleiotropy was observed in MR-Egger intercept test (P > 0.05). These findings evinced that higher BP and PP were causally associated with an increased risk of frailty, suggesting that controlling hypertension could reduce the risk of frailty.
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Affiliation(s)
- Ge Tian
- Xi'an Medical University, Xi'an, 710021, Shaanxi, China
- Department of Geriatric Neurology, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Rong Zhou
- Department of Geriatric Neurology, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Xingzhi Guo
- Department of Geriatric Neurology, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China.
| | - Rui Li
- Xi'an Medical University, Xi'an, 710021, Shaanxi, China.
- Department of Geriatric Neurology, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China.
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Rivasi G, Ceolin L, Turrin G, Tortu’ V, D’Andria MF, Testa GD, Montali S, Tonarelli F, Brunetti E, Bo M, Romero-Ortuno R, Mossello E, Ungar A. Prevalence and correlates of frailty in older hypertensive outpatients according to different tools: the HYPER-FRAIL pilot study. J Hypertens 2024; 42:86-94. [PMID: 37698894 PMCID: PMC10713004 DOI: 10.1097/hjh.0000000000003559] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 07/15/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023]
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.
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Affiliation(s)
- Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Ludovica Ceolin
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Giada Turrin
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Virginia Tortu’
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Maria Flora D’Andria
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Giuseppe Dario Testa
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Sara Montali
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Francesco Tonarelli
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Enrico Brunetti
- Section of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Molinette, Turin, Italy
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Molinette, Turin, Italy
| | - Roman Romero-Ortuno
- Discipline of Medical Gerontology and Falls and Syncope Unit, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Enrico Mossello
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
| | - Andrea Ungar
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence
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Li H, Wu Y, Bai Z, Xu X, Su D, Chen J, He R, Sun J. The Association Between Family Health and Frailty With the Mediation Role of Health Literacy and Health Behavior Among Older Adults in China: Nationwide Cross-Sectional Study. JMIR Public Health Surveill 2023; 9:e44486. [PMID: 37368463 DOI: 10.2196/44486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/07/2023] [Accepted: 05/17/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Family health develops from the intersection of the health of each family member and their interactions and capacities as well as the family's internal and external resources. Frailty is the most prominent and typical clinical manifestation during population aging. Family health may be effective in addressing frailty, and this association may be mediated by health literacy and health behaviors. Until now, it is unclear whether and how family health affects frailty in older adults. OBJECTIVE This study aimed to examine the associations between family health and frailty and the mediation roles of health literacy and health behaviors. METHODS A total of 3758 participants aged ≥60 years were recruited from a national survey conducted in 2022 in China for this cross-sectional study. Family health was measured using the Short Form of the Family Health Scale. Frailty was measured using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale. Potential mediators included health literacy and health behaviors (not smoking, not having alcohol intake, physical exercise for ≥150 minutes per week, longer sleep duration, and having breakfast every day). Ordered logistic regression was applied to explore the association between family health and frailty status. Mediation analysis based on Sobel tests was used to analyze the indirect effects mediated by health literacy and behaviors, and the Karlson-Holm-Breen method was used to composite the indirect effects. RESULTS Ordered logistic regression showed that family health is negatively associated with frailty (odds ratio 0.94, 95% CI 0.93-0.96) with covariates and potential mediators controlled. This association was mediated by health literacy (8.04%), not smoking (1.96%), longer sleep duration (5.74%), and having breakfast every day (10.98%) through the Karlson-Holm-Breen composition. CONCLUSIONS Family health can be an important intervention target that appears to be negatively linked to frailty in Chinese older adults. Improving family health can be effective in promoting healthier lifestyles; improving health literacy; and delaying, managing, and reversing frailty.
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Affiliation(s)
- Haomiao Li
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
| | - Yibo Wu
- School of Public Health, Peking University, Beijing, China
| | - Zhongliang Bai
- School of Health Services Management, Anhui Medical University, Hefei, China
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Xiwu Xu
- Beijing Hospital, Beijing, China
| | - Dai Su
- Department of Health Management and Policy, School of Public Health, Capital Medical University, Beijing, China
| | - Jiangyun Chen
- Institute of Health Management, Southern Medical University, Guangzhou, China
| | - Ruibo He
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
- College of Finance and Public Administration, Hubei University of Economics, Wuhan, China
| | - Ju Sun
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
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Zeng XZ, Jia N, Meng LB, Shi J, Li YY, Hu JB, Hu X, Li H, Xu HX, Li JY, Qi X, Wang H, Zhang QX, Li J, Liu DP. A study on the prevalence and related factors of frailty and pre-frailty in the older population with hypertension in China: A national cross-sectional study. Front Cardiovasc Med 2023; 9:1057361. [PMID: 36712273 PMCID: PMC9877294 DOI: 10.3389/fcvm.2022.1057361] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
Objective To explore the prevalence and factors associated with frailty and pre-frailty in elderly Chinese patients with hypertension. Background In China, there have been few national studies into the prevalence and factors associated with frailty and pre-frailty in elderly patients with hypertension. Methods Through the 4th Sample Survey of Aged Population in Urban and Rural China (SSAPUR) in 2015, the situation of hypertension subjects aged 60 years or older in 31 provinces, autonomous regions, and municipalities in mainland China was obtained. And the frailty index was constructed based on 33 potential defects, elderly hypertensive patients are classified as robust, frailty, and pre-frailty. Results A total of 76,801 elderly patients with hypertension were enrolled in the study. The age-sex standardized prevalence of frailty and pre-frailty in hypertensive elderly in China was 16.1% (95%CI 15.8-16.3%), 58.1% (95%CI 57.7-58.4%). There were significant geographical differences in the prevalence of frailty and pre-frailty in elderly hypertensive patients. Multinomial logistic regression analysis showed that poor economic status, activities of daily living disability, and comorbid chronic diseases were related to frailty and pre-frailty. Conclusion Frailty and pre-frailty are very common in elderly Chinese patients with hypertension and have similar risk factors. Prevention strategies should be developed to stop or delay the onset of frailty by targeting established risk factors in the pre-frailty population of elderly hypertension. It is also crucial to optimize the management of frailty in elderly Chinese patients with hypertension.
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Affiliation(s)
- Xue-zhai Zeng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Na Jia
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ling-bing Meng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Shi
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Ying-ying Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jia-bin Hu
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Xing Hu
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Hui Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hong-xuan Xu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jian-yi Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Qi
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hua Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Juan Li
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - De-ping Liu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China,*Correspondence: De-ping Liu,
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Liu H, Zhou W, Liu Q, Yu J, Wang C. Global Prevalence and Factors Associated with Frailty among Community-Dwelling Older Adults with Hypertension: A Systematic Review and Meta-Analysis. J Nutr Health Aging 2023; 27:1238-1247. [PMID: 38151875 DOI: 10.1007/s12603-023-2035-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/06/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Frailty may increase the risk of adverse outcomes and the presence of comorbidities in hypertension. Understanding the prevalence of frailty in older adults with hypertension is of great importance, whereas estimates of the prevalence of frailty in this population vary greatly. OBJECTIVES A systematic review and meta-analysis was conducted to estimate the pooled prevalence of frailty and prefrailty among community-dwelling older adults with hypertension, and to examine the risk factors associated with (pre)frailty in this population. METHODS PubMed, Web of Science, The Cochrane Library, EMBASE, and CINAHL were searched from the inception to May 10, 2023. Investigators assessed eligibility, extracted data, and evaluated methodological quality. The pooled prevalence of frailty and prefrailty was calculated using the random-effects model. Meta-regression analysis and subgroup analysis were conducted to explore sources of heterogeneity. Sensitivity analysis was undertaken by the leave-one-out method and by removing studies with moderate/high risk of bias. The Mantel-Haenszel or inverse variance method was used to estimate risk factors of frailty. RESULTS A total of 14 studies met the inclusion criteria, involving 185,249 participants. The pooled prevalence in older adults with hypertension was 23% (95% CI 0.09-0.36) for frailty and 46% (95% CI 0.38-0.54) for prefrailty. The pooled prevalence of frailty was greater in studies with a higher proportion of females (24%, 95% CI 0.05-0.50), using multidimensional tools to define frailty (30%, 95% CI 0.10-0.51) and conducted in Western Pacific (27%, 95% CI 0.17-0.39). Age, female sex, depression, and previous hospitalizations were risk factors of frailty among older adults with hypertension. CONCLUSION Frailty and prefrailty are prevalent in community-dwelling older adults with hypertension, and limited risk factors are identified. This implicates the importance of frailty assessment integrated into the routine primary care for older adults with hypertension in community settings as well as the understanding of potential factors.
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Affiliation(s)
- H Liu
- Cuili Wang, PhD, is a senior research scientist, School of Nursing, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China; (C. Wang)
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