Frail by four different measures and new adverse events from lower blood pressure control in hypertensive older adults: a 2-year prospective study in The Irish Longitudinal Study on Ageing (TILDA)

Abstract

Frail by four different measures and new adverse events from lower blood pressure control in hypertensive older adults: a 2-year prospective study in The Irish Longitudinal Study on Ageing (TILDA) Student: Patrick O?Donoghue MB, BCh, BAO INTRODUCTION The 2018 ESC/ESH guidelines for management of hypertension in adults aged ?65 years recommend a BP treatment target of 130?139/70?79 mmHg if tolerated. For the frail, higher BP targets are advised if treatment is not tolerated. Randomised controlled trials advocate for more intensive BP control for all older adults. I compared four different frailty classifications in their ability to predict 2-year adverse clinical outcomes (hospitalisation, falls/fractures, syncope, heart attack, heart failure, stroke/TIA and mortality) for older adults with BP treated intensely (<130/70mmHg) in The Irish Longitudinal Study on Ageing (TILDA). METHODS Participants aged ?65 years in wave 1 (W1) of TILDA treated for hypertension were analysed. Frailty at W1 in these participants was described using 4 different frailty identification tools: the Frailty Phenotype (FP), the Clinical Frailty Scale (CFS), a 32-item self-reported Frailty Index (FI) and the 5-item FRAIL (Fatigue, Resistance, Ambulation, Illness and Loss of Weight) scale. `Intensely? treated BP was defined as <130mmhg SBP and/or<70mmHg DBP. 16 sub-groups were formed at W1 based on a participant?s frailty/BP status. Health outcomes at wave 2 (W2) of TILDA were analysed using binary logistic regression models adjusted for age, sex, education, polypharmacy, classic orthostatic hypotension and MOCA score. The frail by FP or CFS were also adjusted for number of chronic diseases. RESULTS 1,920 W1 participants were aged ?65 years and treated for hypertension. 1,229 had full BP/FP data, 1,282 for BP/CFS, 1,274 for BP/FI, and 1,276 for BP/FRAIL. The non-frail groups in all 4 frailty classifications had no increased risk of any adverse health outcomes at W2. The frail-by-FRAIL scale and BP treated below target were the only sub-group with increased risk of mortality by W2. The frail by FI and FRAIL with BP treated below target both had increased risk of hospitalisation, new heart failure and falls/fractures by W2. CONCLUSION Frailty was independently associated with increased risk of adverse outcomes in hypertensive older adults with BP below ESC/ESH targets. However different frailty classifications had differing prognostic implications. The FRAIL scale, followed by the FI captured the highest number of adverse outcomes from BP treated below the target. FRAIL and FI may be the optimal frailty tools to use when applying the ESC/ESH guideline. Models of frailty that do not explicitly measure comorbidities (such as FP and CFS) may be less useful to capture risk of adverse events from lower BP control. Future studies on intensive BP treatment need to include the frailest adults to truly answer this clinical question.