Skip to main content
SpringerLink
Log in

Global Prevalence and Factors Associated with Frailty among Community-Dwelling Older Adults with Hypertension: A Systematic Review and Meta-Analysis

  • Review
  • Published:
The journal of nutrition, health & aging

Abstract

Background

Frailty may increase the risk of adverse outcomes and the presence of comorbidities in hypertension. Understanding the prevalence of frailty in older adults with hypertension is of great importance, whereas estimates of the prevalence of frailty in this population vary greatly.

Objectives

A systematic review and meta-analysis was conducted to estimate the pooled prevalence of frailty and prefrailty among community-dwelling older adults with hypertension, and to examine the risk factors associated with (pre)frailty in this population.

Methods

PubMed, Web of Science, The Cochrane Library, EMBASE, and CINAHL were searched from the inception to May 10, 2023. Investigators assessed eligibility, extracted data, and evaluated methodological quality. The pooled prevalence of frailty and prefrailty was calculated using the random-effects model. Meta-regression analysis and subgroup analysis were conducted to explore sources of heterogeneity. Sensitivity analysis was undertaken by the leave-one-out method and by removing studies with moderate/high risk of bias. The Mantel-Haenszel or inverse variance method was used to estimate risk factors of frailty.

Results

A total of 14 studies met the inclusion criteria, involving 185,249 participants. The pooled prevalence in older adults with hypertension was 23% (95% CI 0.09–0.36) for frailty and 46% (95% CI 0.38–0.54) for prefrailty. The pooled prevalence of frailty was greater in studies with a higher proportion of females (24%, 95% CI 0.05–0.50), using multidimensional tools to define frailty (30%, 95% CI 0.10–0.51) and conducted in Western Pacific (27%, 95% CI 0.17–0.39). Age, female sex, depression, and previous hospitalizations were risk factors of frailty among older adults with hypertension.

Conclusion

Frailty and prefrailty are prevalent in community-dwelling older adults with hypertension, and limited risk factors are identified. This implicates the importance of frailty assessment integrated into the routine primary care for older adults with hypertension in community settings as well as the understanding of potential factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 1
Figure 3

Similar content being viewed by others

Availability of data and materials: The datasets generated for this study are available on request to the corresponding author.

References

  1. Ijaz N, Buta B, Xue QL, et al. Interventions for Frailty Among Older Adults With Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79(5): 482–503.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Dent E, Martin FC, Bergman H, Woo J, Romero-Ortuno R, Walston JD. Management of frailty: opportunities, challenges, and future directions. Lancet 2019; 394(10206): 1376–86.

    Article  PubMed  Google Scholar 

  3. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56(3): M146–56.

    Article  CAS  PubMed  Google Scholar 

  4. Benetos A, Petrovic M, Strandberg T. Hypertension Management in Older and Frail Older Patients. Circ Res 2019; 124(7): 1045–60.

    Article  CAS  PubMed  Google Scholar 

  5. Liu P, Li Y, Zhang Y, Mesbah SE, Ji T, Ma L. Frailty and hypertension in older adults: current understanding and future perspectives. Hypertens Res 2020; 43(12): 1352–60.

    Article  PubMed  Google Scholar 

  6. Ma L, Zhang L, Sun F, Li Y, Tang Z. Frailty in Chinese older adults with hypertension: Prevalence, associated factors, and prediction for long-term mortality. J Clin Hypertens (Greenwich) 2018; 20(11): 1595–602.

    Article  PubMed  Google Scholar 

  7. Ma L, Chhetri JK, Liu P, Ji T, Zhang L, Tang Z. Epidemiological characteristics and related factors of frailty in older Chinese adults with hypertension: a population-based study. J Hypertens 2020; 38(11): 2192–7.

    Article  CAS  PubMed  Google Scholar 

  8. Bielecka-Dabrowa A, Ebner N, Dos Santos MR, Ishida J, Hasenfuss G, von Haehling S. Cachexia, muscle wasting, and frailty in cardiovascular disease. Eur J Heart Fail 2020; 22(12): 2314–26.

    Article  PubMed  Google Scholar 

  9. Damluji AA, Chung S-E, Xue Q-L, et al. Frailty and cardiovascular outcomes in the National Health and Aging Trends Study. EUROPEAN HEART JOURNAL 2021; 42(37): 3856–65.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Anker D, Carmeli C, Zwahlen M, et al. How blood pressure predicts frailty transitions in older adults in a population-based cohort study: a multi-state transition model. INTERNATIONAL JOURNAL OF EPIDEMIOLOGY 2022; 51(4): 1167–77.

    Article  PubMed  Google Scholar 

  11. Zeng XZ, Jia N, Meng LB, et al. A study on the prevalence and related factors of frailty and pre-frailty in the older population with hypertension in China: A national cross-sectional study. Frontiers in Cardiovascular Medicine 2023; 9.

  12. Castrejón-Pérez RC, Gutiérrez-Robledo LM, Cesari M, Pérez-Zepeda MU. Diabetes mellitus, hypertension and frailty: A population-based, cross-sectional study of Mexican older adults. Geriatrics and Gerontology International 2017; 17(6): 925–30.

    Article  PubMed  Google Scholar 

  13. Anker D, Santos-Eggimann B, Zwahlen M, et al. Blood pressure in relation to frailty in older adults: A population-based study. JOURNAL OF CLINICAL HYPERTENSION 2019; 21(12): 1895–904.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Coelho-Junior HJ, Uchida MC, Picca A, et al. Frailty is not associated with hypertension, blood pressure or antihypertensive medication in community-dwelling older adults: A cross-sectional comparison across 3 frailty instruments. Experimental Gerontology 2021; 146.

  15. Damluji AA, Chung S-E, Xue Q-L, et al. Physical Frailty Phenotype and the Development of Geriatric Syndromes in Older Adults with Coronary Heart Disease. AMERICAN JOURNAL OF MEDICINE 2021; 134(5): 662-+.

    Article  PubMed  Google Scholar 

  16. Ekram ARMS, Espinoza SE, Ernst ME, et al. The Association between Metabolic Syndrome, Frailty and Disability-Free Survival in Healthy Community-dwelling Older Adults. JOURNAL OF NUTRITION HEALTH & AGING 2023; 27(1): 1–9.

    Article  CAS  Google Scholar 

  17. García-de-Alba-García JE, Salcedo-Rocha AL, De-la-Rosa-Hernández S. The status of frailty in poor older adults with type 2 diabetes mellitus or hypertension: the case of Mexico. International Journal of Diabetes in Developing Countries 2020; 40(2): 303–9.

    Article  Google Scholar 

  18. Lefferts EC, Bakker EA, Carbone S, Lavie CJ, Lee DC. Associations of total and aerobic steps with the prevalence and incidence of frailty in older adults with hypertension. Prog Cardiovasc Dis 2021; 67: 18–25.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Shen F, Chen J, Yang R, Yang J, Li H. Association between control status of blood pressure and frailty among middle-aged and older adults with hypertension in China: a longitudinal study. BMJ OPEN 2022; 12(3).

  20. Song X, Zhang W, Hallensleben C, et al. Associations Between Obesity and Multidimensional Frailty in Older Chinese People with Hypertension. Clin Interv Aging 2020; 15: 811–20.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical research ed) 2021; 372: n71.

    PubMed  Google Scholar 

  22. Muntner P, Hardy ST, Fine LJ, et al. Trends in Blood Pressure Control Among US Adults With Hypertension, 1999–2000 to 2017–2018. JAMA 2020; 324(12): 1190–200.

    Article  PubMed  Google Scholar 

  23. Hoy D, Brooks P, Woolf A, et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol 2012; 65(9): 934–9.

    Article  PubMed  Google Scholar 

  24. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ (Clinical research ed) 2003; 327(7414): 557–60.

    Article  PubMed  Google Scholar 

  25. Ravindrarajah R, Hazra NC, Hamada S, et al. Systolic Blood Pressure Trajectory, Frailty, and All-Cause Mortality > 80 Years of Age Cohort Study Using Electronic Health Records. CIRCULATION 2017; 135(24): 2357-+.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Fattori A, Santimaria MR, Alves RMA, Guariento ME, Neri AL. Influence of blood pressure profile on frailty phenotype in community-dwelling elders in Brazil - FIBRA study. ARCHIVES OF GERONTOLOGY AND GERIATRICS 2013; 56(2): 343–9.

    Article  CAS  Google Scholar 

  27. Frisoli A,Jr., McNeill Ingham SJ, Paes AT, et al. Frailty predictors and outcomes among older patients with cardiovascular disease: Data from Fragicor. ARCHIVES OF GERONTOLOGY AND GERIATRICS 2015; 61(1): 1–7.

    Article  Google Scholar 

  28. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 2012; 60(8): 1487–92.

    Article  PubMed  Google Scholar 

  29. Khan MS, Segar MW, Usman MS, et al. Frailty, Guideline-Directed Medical Therapy, and Outcomes in HFrEF: From the GUIDE-IT Trial. JACC Heart Fail 2022; 10(4): 266–75.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Forman DE, Alexander KP. Frailty: A Vital Sign for Older Adults With Cardiovascular Disease. Can J Cardiol 2016; 32(9): 1082–7.

    Article  PubMed  Google Scholar 

  31. Stout MB, Justice JN, Nicklas BJ, Kirkland JL. Physiological Aging: Links Among Adipose Tissue Dysfunction, Diabetes, and Frailty. Physiology (Bethesda) 2017; 32(1): 9–19.

    CAS  PubMed  Google Scholar 

  32. Patel TP, Rawal K, Bagchi AK, et al. Insulin resistance: an additional risk factor in the pathogenesis of cardiovascular disease in type 2 diabetes. Heart Fail Rev 2016; 21(1): 11–23.

    Article  CAS  PubMed  Google Scholar 

  33. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. Cmaj 2005; 173(5): 489–95.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004; 59(3): 255–63.

    Article  PubMed  Google Scholar 

  35. Dent E, Lien C, Lim WS, et al. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. Journal of the American Medical Directors Association 2017; 18(7): 564–75.

    Article  PubMed  Google Scholar 

  36. Cesari M, Calvani R, Marzetti E. Frailty in Older Persons. Clin Geriatr Med 2017; 33(3): 293–303.

    Article  PubMed  Google Scholar 

  37. Rivasi G, Ceolin L, Turrin G, et al. Prevalence and correlates of frailty in older hypertensive outpatients according to different tools: the HYPER-FRAIL pilot study. J Hypertens 2023.

  38. Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet 2019; 394(10206): 1365–75.

    Article  PubMed  Google Scholar 

  39. Beurel E, Toups M, Nemeroff CB. The Bidirectional Relationship of Depression and Inflammation: Double Trouble. Neuron 2020; 107(2): 234–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Kiecolt-Glaser JK, Derry HM, Fagundes CP. Inflammation: depression fans the flames and feasts on the heat. Am J Psychiatry 2015; 172(11): 1075–91.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Guidet B, de Lange DW, Boumendil A, et al. The contribution of frailty, cognition, activity of daily life and comorbidities on outcome in acutely admitted patients over 80 years in European ICUs: the VIP2 study. Intensive Care Med 2020; 46(1): 57–69.

    Article  CAS  PubMed  Google Scholar 

  42. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens 2018; 36(10): 1953–2041.

    Article  CAS  PubMed  Google Scholar 

  43. Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension 2020; 75(6): 1334–57.

    Article  CAS  PubMed  Google Scholar 

  44. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 71(19): e127–e248.

    Article  PubMed  Google Scholar 

  45. Bakris G, Ali W, Parati G. ACC/AHA Versus ESC/ESH on Hypertension Guidelines: JACC Guideline Comparison. J Am Coll Cardiol 2019; 73(23): 3018–26.

    Article  PubMed  Google Scholar 

  46. Hua Q, Fan L, Li J, Wang ZW. 2023 Hypertension Branch of Chinese Geriatrics Society Guideline for the Management of Hypertension in the Elderly in China. Chin J Hypertens 2023; 31(06): 508–38.

    Google Scholar 

  47. Woo J, Yu R, Tsoi K, Meng H. Variability in Repeated Blood Pressure Measurements as a Marker of Frailty. J Nutr Health Aging 2018; 22(9): 1122–7.

    Article  CAS  PubMed  Google Scholar 

  48. Rouch L, Barreto PDS, Hanon O, et al. Visit-to-Visit Blood Pressure Variability and Incident Frailty in Older Adults. J Gerontol Ser A-Biol Sci Med Sci 2021; 76(8): 1369–75.

    Google Scholar 

  49. Moonga I, Niccolini F, Wilson H, Pagano G, Politis M. Hypertension is associated with worse cognitive function and hippocampal hypometabolism in Alzheimer’s disease. Eur J Neurol 2017; 24(9): 1173–82.

    Article  CAS  PubMed  Google Scholar 

  50. Tseng SH, Liu LK, Peng LN, Wang PN, Loh CH, Chen LK. Development and Validation of a Tool to Screen for Cognitive Frailty among Community-Dwelling Elders. J Nutr Health Aging 2019; 23(9): 904–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors gratefully thank the China Postdoctoral Science Foundation (grant number 2022TQ0016 and 2022M720298) for funding this research.

Funding

Funding sources: This paper was supported by the Project funded by China Postdoctoral Science Foundation (grant number 2022TQ0016 and 2022M720298).

Author information

Author notes

  1. These two authors contributed equally to this work.

Authors and Affiliations

  1. School of Nursing, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China

    H. Liu, W. Zhou, Q. Liu, J. Yu & Cuili Wang

Authors
  1. H. Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Q. Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cuili Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CRediT authorship contribution statement: H Liu: Conceptualization, Writing - original draft, Data curation, Writing - review & editing, Funding acquisition. W Zhou: Conceptualization, Writing - original draft, Formal analysis, Data curation, Writing - review & editing. Q Liu: Conceptualization, Data curation, Writing - review & editing. J Yu: Conceptualization, Data curation, Writing - review & editing. C Wang: Conceptualization, Writing - original draft, Data curation, Writing - review & editing.

Corresponding author

Correspondence to Cuili Wang.

Ethics declarations

Ethical approval: Not required.

Declaration of Conflict of Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liu, H., Zhou, W., Liu, Q. et al. Global Prevalence and Factors Associated with Frailty among Community-Dwelling Older Adults with Hypertension: A Systematic Review and Meta-Analysis. J Nutr Health Aging 27, 1238–1247 (2023). https://doi.org/10.1007/s12603-023-2035-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-023-2035-5

Key words

Search

Navigation