How blood pressure predicts frailty transitions in older adults in a population-based cohort study: a multi-state transition model.

Anker, Daniela; Carmeli, Cristian; Zwahlen, Marcel; Rodondi, Nicolas; Santschi, Valérie; Henchoz, Yves; Wolfson, Christina; Chiolero, Arnaud (2022). How blood pressure predicts frailty transitions in older adults in a population-based cohort study: a multi-state transition model. International journal of epidemiology, 51(4), pp. 1167-1177. Oxford University Press 10.1093/ije/dyab210

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BACKGROUND

Low blood pressure (BP) is associated with frailty in older adults. Our aim was to explore how BP predicts transitions between frailty states.

METHODS

We used data from the Lausanne cohort Lc65+, a population-based cohort of older adults randomly drawn from a population registry in Switzerland, in 2004, 2009 and 2014. BP was measured using a clinically validated oscillometric automated device and frailty was defined using Fried's phenotype, every 3 years. We used an illness-death discrete multi-state Markov model to estimate hazard ratios of forward and backward transitions between frailty states (outcome) in relation to BP categories (predictor of interest) with adjustment for sex, age and antihypertensive medication (other predictors).

RESULTS

Among 4200 participants aged 65-70 years (58% female) at baseline, 70% were non-frail, 27% pre-frail and 2.0% frail. Over an average follow-up of 5.8 years, 2422 transitions were observed, with 1575 (65%) forward and 847 (35%) backward. Compared with systolic BP (SBP) <130 mmHg, the hazard ratio (95% confidence interval) of the transition from non-frail to pre-frail was 0.86 (0.74 to 1.00) for SBP 130-150 mmHg, and 0.89 (0.74 to 1.06) for SBP ≥150 mmHg. Compared with SBP <130 mmHg, the hazard ratio of the transition from pre-frail to frail was 0.71 (0.50 to 1.01) for SBP 130-150 mmHg, and 0.90 (0.62 to 1.32) for SBP ≥150 mmHg. Diastolic BP was a weaker predictor of forward transitions.

CONCLUSIONS

BP categories had no strong relationship with either forward transitions or backward transitions in frailty states. If our findings are confirmed with greater precision and assuming a causal relationship, they would suggest that there is no well-defined optimal BP level to prevent frailty among older adults.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Zwahlen, Marcel, Rodondi, Nicolas, Chiolero, Arnaud

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0300-5771

Publisher:

Oxford University Press

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Tobias Tritschler

Date Deposited:

19 Oct 2021 12:30

Last Modified:

05 Dec 2022 15:53

Publisher DOI:

10.1093/ije/dyab210

PubMed ID:

34652417

Uncontrolled Keywords:

Blood pressure ageing cohort studies epidemiology frailty

BORIS DOI:

10.48350/160189

URI:

https://boris.unibe.ch/id/eprint/160189

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