High systolic BPV tied to greater frailty risk in older adults

An elevated systolic blood pressure (BP) variability (BPV) in healthy older adults may lead to a higher risk of frailty regardless of their mean BP, suggests a study.

This secondary analysis of BPV and incident frailty was conducted in more than 13,000 participants (aged 65 to 70 years) enrolled in the Aspirin in Reducing Events in the Elderly (ASPREE) trial and its observational follow-up (ASPREE-XT).

Eligible participants had no dementia, physical disability, or cardiovascular disease at baseline. Those with frailty during the BPV estimation period were excluded from the analysis.

The research team estimated BPV using standard deviation of mean BP from three annual visits (baseline through the second annual follow-up). They defined frailty using the Fried phenotype and the frailty deficit accumulation index (FDAI).

Finally, the researchers explored the relationship between BPV and incident frailty using adjusted Cox proportional hazards regression and the change in frailty scores using linear mixed models through 9 years of follow-up.

Frailty risk was highest among older adults in the highest systolic BPV tertile compared to those in the lowest (referent) tertile (Fried hazard ratio [HR], 1.17, 95 percent confidence interval [CI], 1.04‒1.31; FDAI HR, 1.18, 95 percent CI, 1.07‒1.30).

These finding persisted even after adjusting for multiple covariates and when stratified by use of antihypertensive medication. In linear mixed models, an association was observed between higher systolic BPV and increasing frailty score over time. Notably, diastolic BPV showed no consistent association with frailty.

“Variability of BP across visits, even in healthy older adults, can convey important risk information beyond mean BP,” the researchers said.