Abstract
Background and objective
Frailty and disability are associated with cardiovascular risk factors, including
hypertension, in older people; however, little is known about their association with
ambulatory blood pressure (BP). Thus, we assessed the relationship of frailty and
disability with ambulatory BP in older adults.
Design, setting, and participants
Cross-sectional study of 1047 community-living individuals aged ≥60 years in Spain.
Measurements
BP was determined with validated devices under standardized conditions during 24 hours.
Frailty was defined as having 3 or more of the following criteria: weight loss, low
grip strength, low energy, slow gait speed, and low physical activity. Disability
was assessed with the Lawton-Brodýs questionnaire on instrumental activities of daily
living. Associations with systolic BP (SBP) and dipping (nocturnal SBP decline) were
modeled and adjusted for sociodemographic variables, body mass index, lifestyles,
antihypertensive drug treatment, comorbidities, 24-hour heart rate, and conventional
or ambulatory SBP as appropriate.
Results
Participants' mean age was 71.7 years (50.8% men); 6% were frail and 8.1% had disability.
Compared with nonfrail participants, those with frailty had 3.5 mm Hg lower daytime
SBP (P = .001), 3.3% less SBP dipping (P = .003), and 3.6 mmHg higher nighttime SBP (P = .016). Compared with participants who are not disabled, those who are disabled
had 2.5 mmHg lower daytime SBP (P = .002), 2.5% less SBP dipping (P = .003), and 2.7 mmHg higher nighttime SBP (P = .011).
Conclusions
In community-dwelling older adults, frailty and disability were independently associated
with lower diurnal SBP, blunted nocturnal decline of SBP, and higher nocturnal SBP.
These findings may help explain the higher mortality associated with low clinic SBP
in frail older subjects observed in epidemiologic studies.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States.JAMA. 2003; 289: 2363-2369
- Prevalence, awareness, treatment and control of hypertension in rural and urban communities in high-, middle-, and low-income countries.JAMA. 2013; 310: 959-968
- Association between concurrent and remote blood pressure and disability in older adults.Hypertension. 2007; 50: 1026-1032
- Hypertension.Lancet. 2015; 386: 801-812
- Ambulatory blood pressure monitoring.N Engl J Med. 2006; 354: 2638-2674
- Noninvasive 24-h ambulatory blood pressure and cardiovascular disease: A systematic review and meta-analysis.J Hypertens. 2008; 26: 1290-1299
- ESH/ESC Guidelines for the management of arterial hypertension. The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).J Hypertens. 2013; 31: 1281-1357
- European Society of Hypertension position paper on ambulatory blood pressure monitoring.J Hypertens. 2013; 31: 1731-1768
- Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension.Hypertension. 2008; 51: 55-61
- Prognostic accuracy of day versus night ambulatory blood pressure: A cohort study.Lancet. 2007; 370: 1219-1229
- Prognostic impact from clinic, daytime, and night-time systolic blood pressure in nine cohorts of 13,844 patients with hypertension.J Hypertens. 2014; 32: 2332-2340
- Prognostic effect of the nocturnal blood pressure fall in hypertensive patients: The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) Meta-Analysis.Hypertension. 2016; 67: 693-700
- Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure: The Ohasama study.J Hypertens. 2002; 20: 2183-2189
- Research agenda for frailty in older adults: Toward a better understanding of physiology and etiology: Summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults.J Am Geriatr Soc. 2006; 54: 991-1001
- Untangling the concepts of disability, frailty and comorbidity: Implications for improved targeting and care.J Gerontol Biol Sci Med Sci. 2004; 59: 255-263
- Blood pressure in older adults: The importance of frailty.Curr Hypertens Rep. 2015; 17: 55
- Racial disparity in cognitive and functional disability in hypertension and all-cause mortality.Am J Hypertens. 2016; 29: 185-193
- Cardiovascular risk profile and frailty in a population-based study of older British men.Heart. 2015; 101: 616-622
- Rethinking the association of high blood pressure with mortality in elderly adults: The impact of frailty.Arch Intern Med. 2012; 172: 1162-1168
- Association of poor physical function and cognitive dysfunction with high nocturnal blood pressure level in treated elderly hypertensive patients.Am J Hypertens. 2011; 24: 285-291
- Association of frailty syndrome in the elderly with higher blood pressure and other cardiovascular risk factors.Am J Hypertens. 2012; 25: 1156-1161
- Association of blood pressure elevation and nocturnal dipping with brain atrophy, perfusion and functional measures in stroke and non-stroke individuals.Am J Hypertens. 2010; 23: 17-23
- Treatment of hypertension in the oldest old: A critical role for frailty?.Hypertension. 2014; 63: 433-441
- Lower systolic blood pressure is associated with greater mortality in people aged 85 and older.J Am Geriatr Soc. 2008; 56: 1853-1859
- In a population-based prospective study, no association between high blood pressure and mortality after age 85 years.J Hypertens. 2006; 24: 287-292
- Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP Hypertension).Lancet. 1991; 338: 1281-1285
- Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension: The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators.Lancet. 1997; 350: 757-764
- Treatment of hypertension in patients 80 years of age or older.N Engl J Med. 2008; 358: 1887-1898
- Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 Years: A randomized clinical trial.JAMA. 2016; 315: 2673-2682
- Characterizing frailty status in the Systolic Blood Pressure Intervention Trial.J Gerontol A Biol Sci Med Sci. 2016; 71: 649-655
- No evidence that frailty modifies the positive impact of antihypertensive treatment in very elderly people: An investigation of the impact of frailty upon treatment effect in the Hypertension in the Very Elderly Trial (HYVET) study, a double blind placebo-controlled study of antihypertensives in people with hypertension aged 80 and over.BMC Med. 2015; 13: 78
- Rationale and methods of the study on nutrition and cardiovascular risk in Spain (ENRICA).Rev Esp Cardiol. 2011; 64: 876-882
- Impact of Ambulatory Blood Pressure Monitoring on reclassification of hypertension prevalence and control in older people in Spain.J Clin Hypertens (Greenwich). 2015; 17: 453-461
- Validation of the Microlife WatchBP O3 device for clinic, home, and ambulatory blood pressure measurement, according to the International Protocol.Blood Press Monit. 2010; 15: 59-62
- Frailty in older adults: Evidence for a phenotype.J Gerontol A Biol Sci Med Sci. 2001; 56: M146-M156
- Assessment of older people: Self-maintaining and instrumental activities of daily living.Gerontologist. 1969; 9: 179-186
- Relative validity and reproducibility of a diet history questionnaire in Spain. I. Foods. European Prospective Investigation into Cancer and Nutrition.Int J Epidemiol. 1997; 26: S91-S99
- Validity and reproducibility of a Spanish dietary history.PLoS One. 2014; 9: e86074
- A short screener is valid for assessing Mediterranean diet adherence among older Spanish men and women.J Nutr. 2011; 141: 1140-1145
- Nonexercise cardiorespiratory fitness and mortality in older adults.Med Sci Sports Exerc. 2015; 47: 568-574
- Mediterranean diet and changes in sleep duration and indicators of sleep quality in older adults.Sleep. 2017; 40https://doi.org/10.1093/sleep/zsw083
- Nocturnal hypertension or nondipping: which is better associated with the cardiovascular risk profile?.Am J Hypertens. 2014; 27: 680-687
- Management of nocturnal hypertension.Expert Rev Cardiovasc Ther. 2009; 7: 607-618
- Frailty in elderly people.Lancet. 2013; 381: 752-762
- Prevalence of frailty in community dwelling older persons: A systematic review.J Am Geriatr Soc. 2012; 60: 1487-1492
- Best practice guidelines for the management of frailty: A British Geriatrics Society, Age UK and Royal College of General Practitioners report.Age Ageing. 2014; 43: 744-747
- The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty.J Am Med Dir Assoc. 2017; 18: 564-575
- Ambulatory physical activity as a determinant of diurnal blood pressure variation.Hypertension. 1999; 34: 685-691
- An expert opinion from the European Society of Hypertension-European Union Geriatric Medicine Society Working Group on the management of hypertension in very old, frail subjects.Hypertension. 2016; 67: 820-825
- Systolic blood pressure trajectory, frailty, and all-cause mortality >80 years of age: Cohort study using electronic health records.Circulation. 2017; 135: 2357-2368
Article info
Publication history
Published online: December 30, 2017
Footnotes
This work was supported by Fondo de Investigación Sanitaria (FIS) grant no. 16/01460 (Instituto de Salud Carlos III and FEDER/FSE), CIBERESP, the FRAILOMIC Initiative (FP7-HEALTH-2012-Proposal no. 305483-2) and the ATHLOS project (EU H2020- Project ID: 635316). The funding agencies had no role in study design, data analysis, interpretation of results, manuscript preparation or in the decision to submit this manuscript for publication.
The authors declare no conflicts of interest.
Identification
Copyright
© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
