BP-lowering meds help improve hypertension outcomes even in frail individuals

In older adults with hypertension, the presence of frailty does not appear to reduce the effectiveness of antihypertensive treatment, according to a study.

Researchers used data from the Systolic Hypertension in the Elderly Program trial. They constructed a baseline frailty index (FI), including 55 variables. Fine-Gray subdistribution hazard models and Cox proportional hazards regression models were applied to investigate the association between baseline frailty index and the risks of stroke, cardiovascular disease, and all-cause death, as well as whether the impact of antihypertensive treatment on these outcomes was modified by baseline frailty index.

The analysis included 4,692 participants (mean age 72.1 years, 56.7 percent women), with a mean FI of 0.134. Over a median follow-up period of 4.4 years, participants with frailty had an increased risk of stroke (per SD higher FI: subdistribution hazard ratio [sHR], 1.24, 95 percent confidence interval [CI], 1.10–1.39), cardiovascular disease (sHR, 1.18, 95 percent CI, 1.09–1.26), and all-cause death (HR, 1.37, 95 percent CI, 1.26–1.50).

Participants with higher levels of frailty were at higher risk for all outcomes. Nevertheless, there was no evidence of an interaction between baseline FI and antihypertensive treatment (p>0.05 for interaction for all outcomes).

The present data align with evidence from other seminal antihypertensive trials, which guide the management of hypertension in frail populations.