Frailty in hypertensive population and its association with all-cause mortality: data from the National Health and Nutrition Examination Survey

Association between frailty with kidney stones disease among adults aged 20 years and older population: a cross-sectional study of NHANES 2007-2020

PURPOSE

Kidney stones (KS) disease is a growing global health concern, increasing prevalence. Its well-established associations with metabolic disorders such as diabetes and hypertension, but the relationship between frailty and KS remains underexplored. This study aims to investigate the association between KS and frailty among adults aged 20 years and older population.

METHODS

This study investigates the relationship between frailty and KS prevalence using data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2020. Frailty was assessed using the Frailty Index (FI), a continuous variable based on 49 health deficits, and categorized into robust, pre-frail, and frail states. Weighted logistic regression and restricted cubic splines (RCS) were used to assess the association between KS and frailty.

RESULTS

A total of 28,113 people were included in the study, and the overall prevalence of KS occurrence was 9.576%. The FI in the KS group was higher than that in the no KS group [0.142(0.094-0.216) vs 0.112(0.073-0.172), p < 0.0001]. Furthermore, the rate of frail status (17.691% vs 9.791%, p < 0.0001) and pre-frail status (54.267% vs 46.929%, p < 0.0001) in the KS group were higher than that in the no KS group. Multivariate logistic regression models revealed a significant positive association between frailty and KS prevalence, with frail individuals showing a 1.731-fold increased likelihood compared to robust individuals (95% CI 1.406-2.131, p < 0.0001). A nonlinear relationship was observed between the FI and KS occurrence, with likelihood increasing as frailty levels rose. Subgroup analyses indicated that frailty had the greatest impact on KS likelihood in individuals under 60 years, of normal weight, and without hypertension.

CONCLUSIONS

In adults in the United States, increased frailty is strongly associated with a higher likelihood of developing KS. Early identification and targeted management of frailty could play a crucial role in reducing the prevalence and recurrence of KS.

Association of changes in frailty with mortality in the aged with hypertension

Previous studies found that frailty has a significant impact on the prognosis of hypertensive patients. However, most of the previous studies only focused on baseline frailty status. The association of changes in frailty with mortality in hypertensive patients is little known. Therefore, we aimed to investigate the association of frailty transitions with all-cause mortality and cardiovascular death in older adults with hypertension. A total of 1827 older hypertensive participants age ≥ 65 years from the Chinese Longitudinal Healthy Longevity Study were included. Frailty status was assessed by a 35-item frailty index (FI). Changes in frailty were evaluated by frailty at baseline (wave 2011) and the second survey (wave 2014), and four types of changes in frailty were identified: remaining non-frail, frail to non-frail, non-frail to frail, and remaining frail. The accelerated failure time model was used to evaluate the association of changes in frailty status with all-cause mortality and cardiovascular death. The dose-response relationship between annual changes in FI and mortality was analyzed using restricted cubic splines (RCS). During 6128.9 person-years of follow-up, a total of 623 all-cause mortality and 131 cardiovascular deaths were recorded. Compared to the remaining non-frail group, the fully adjusted time ratios (TRs) of all-cause mortality were 0.75 (95% CI 0.59-0.96, p = 0.025), 0.48 (95% CI 0.41-0.57, p < 0.001), and 0.45 (95% CI 0.37-0.55, p < 0.001) in the frail to non-frail group, non-frail to frail group, and remaining frail group, respectively. After adjusting for potential confounding variables, the adjusted TRs of cardiovascular death were 0.63 (95% CI 0.36-1.11, p = 0.108), 0.34 (95% CI 0.23-0.48, p < 0.001), and 0.34 (95% CI 0.22-0.53, p < 0.001) in the frail to non-frail group, non-frail to frail group, and remaining frail group, respectively. RCS analysis revealed a non-linear relationship between annual changes in FI and all-cause mortality and cardiovascular death (both p for non-linearity < 0.05). Stratified and sensitivity analysis showed similar results. Frailty is a dynamic process, and worsening in frailty status accelerated all-cause mortality and cardiovascular death in older adults with hypertension. In contrast, improvement in frailty status prolonged the survival time of patients.

The relationship between frailty syndrome and quality of life in patients with hypertension: a multidimensional analysis

BACKGROUND

Hypertension is a common condition among the elderly and is frequently accompanied by frailty syndrome (FS). The coexistence of hypertension and FS poses significant challenges in patient management and negatively impacts the quality of life (QoL). This study aimed to analyze the relationship between FS and QoL in elderly patients with suspected hypertension.

METHODS

A cross-sectional study was conducted involving 201 patients aged 65 years or older, referred to a Hypertension Clinic for diagnostic evaluation. Frailty was assessed using the Tilburg Frailty Indicator (TFI), and QoL was evaluated with the World Health Organization Quality of Life Instrument (WHOQOL-BREF). Sociodemographic and clinical data were collected, and statistical analyses were performed to identify correlations between FS and QoL.

RESULTS

The study found that 79.60% of the patients were identified as frail (TFI ≥ 5). FS was significantly negatively correlated with all domains of QoL, including physical health (r = -0.634, p < 0.001), psychological health (r = -0.675, p < 0.001), social relationships (r = -0.528, p < 0.001), and environmental factors (r = -0.626, p < 0.001). Multivariate analysis revealed that physical (β = -0.091, p < 0.001) and psychological components of FS (β = -0.128, p = 0.016), as well as age (β = -0.022, p = 0.004), were significant predictors of lower QoL scores. Loneliness (β = -0.235, p = 0.049) was also a significant predictor of lower QoL.

CONCLUSIONS

The study demonstrated a strong association between FS and reduced QoL in elderly hypertensive patients, emphasizing the need for comprehensive assessments and personalized management strategies. Routine evaluation of frailty and the implementation of targeted interventions aimed at improving physical, psychological, and social well-being could substantially enhance QoL in this vulnerable population.

CLINICAL TRIAL NUMBER

Not applicable.

Hypertension in frail older adults: current perspectives

Hypertension is one of the most common chronic diseases in older people, and the prevalence is on the rise as the global population ages. Hypertension is closely associated with many adverse health outcomes, including cardiovascular disease, chronic kidney disease and mortality, which poses a substantial threat to global public health. Reasonable blood pressure (BP) management is very important for reducing the occurrence of adverse events. Frailty is an age-related geriatric syndrome, characterized by decreased physiological reserves of multiple organs and systems and increased sensitivity to stressors, which increases the risk of falls, hospitalization, fractures, and mortality in older people. With the aging of the global population and the important impact of frailty on clinical practice, frailty has attracted increasing attention in recent years. In older people, frailty and hypertension often coexist. Frailty has a negative impact on BP management and the prognosis of older hypertensive patients, while hypertension may increase the risk of frailty in older people. However, the causal relationship between frailty and hypertension remains unclear, and there is a paucity of research regarding the efficacious management of hypertension in frail elderly patients. The management of hypertension in frail elderly patients still faces significant challenges. The benefits of treatment, the optimal BP target, and the choice of antihypertensive drugs for older hypertensive patients with frailty remain subjects of ongoing debate. This review provides a brief overview of hypertension in frail older adults, especially for the management of BP in this population, which may help in offering valuable ideas for future research in this field.

Association of frailty status with overall survival in elderly hypertensive patients: based on the Chinese Longitudinal Healthy Longevity Survey

BACKGROUND

Hypertension and frailty often coexist in older people. The present study aimed to evaluate the association of frailty status with overall survival in elderly hypertensive patients, using data from the Chinese Longitudinal Healthy Longevity Survey.

METHODS

A total of 10,493 elderly hypertensive patients were included in the present study (median age 87.0 years, 58.3% male). Frailty status was assessed according to a 36-item frailty index (FI), which divides elderly individuals into four groups: robustness (FI ≤ 0.10), pre-frailty (0.10 < FI ≤ 0.20), mild-frailty (0.20 < FI ≤ 0.30), and moderate-severe frailty (FI > 0.30). The study outcome was overall survival time. Accelerated failure time model was used to evaluate the association of frailty status with overall survival.

RESULTS

During a period of 44,616.6 person-years of follow-up, 7327 (69.8%) participants died. The overall survival time was decreased with the deterioration of frailty status. With the robust group as reference, adjusted time ratios (TRs) were 0.84 (95% confidence interval [CI]: 0.80-0.87) for the pre-frailty group, 0.68 (95% CI: 0.64-0.72) for the mild frailty group, and 0.52 (95% CI: 0.48-0.56) for the moderate-severe frailty group, respectively. In addition, restricted cubic spline analysis revealed a nearly linear relationship between FI and overall survival (p for non-linearity = 0.041), which indicated the overall survival time decreased by 17% with per standard deviation increase in FI (TR = 0.83, 95% CI: 0.82-0.85). Stratified and sensitivity analyses suggested the robustness of the results.

CONCLUSIONS

The overall survival time of elderly hypertensive patients decreased with the deterioration of frailty status. Given that frailty is a dynamic and even reversible process, early identification of frailty and active intervention may improve the prognosis of elderly hypertensive patients.

Effect of blood pressure on mortality in patients with cognitive impairment: a prospective cohort study

Background

Cognitive impairment is a prevalent condition that substantially elevates mortality rates among the elderly. The impact of hypertension on mortality in older adults with cognitive impairment is a subject of contention. This study aims to examine the influence of hypertension on both all-cause and CVD-specific mortality in elderly individuals experiencing cognitive impairment within a prospective cohort.

Methods

This study encompassed 2,925 participants (weighted 53,086,905) aged 60 years or older from National Health and Nutrition Examination Survey (NHANES) spanning 2011-2014. Incidence of all-cause and CVD-specific mortality was ascertained through linkage with National Death Index records until 31 December 2019. Survival was performed employing the Kaplan-Meier method. Hazard ratios (HRs) were calculated via Cox proportional hazards regression models.

Results

Over the follow-up period of up to 9.17 years [with a median (IQR) time to death of 6.58 years], equivalent to 18,731.56 (weighted 3.46 × 108) person-years, there were a total of 576 recorded deaths. Participants with CI exhibited a 1.96-fold higher risk of all-cause mortality (95% CI: 1.55-2.49; p < 0.01) and a 2.8-fold higher risk of CVD-specific mortality (95% CI: 1.83-4.29; p < 0.01) in comparison to participants without CI. Among participants with CI, concurrent hypertension comorbidity was linked to a 2.73-fold elevated risk of all-cause mortality (95% CI: 1.78-4.17; p < 0.01) and a 5.3-fold elevated risk of CVD-specific mortality (95% CI: 2.54-11.04; p < 0.01). Further stratified analyses revealed that the combined effects of hypertension and CI on all-cause and CVD-specific mortality were more pronounced in participants aged 60-69 years compared to those aged 70-80 years (p for interaction <0.01). The primary findings exhibited resilience across a series of sensitivity analyses.

Conclusions

Participants with CI exhibited a markedly elevated risk of all-cause and CVD-specific mortality when coexisting with hypertension. Appropriate management of hypertension in patients with CI may be helpful in reducing the excess risk of death.