Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Special Issue: Current evidence and perspectives for hypertension management in Asia
  • Published:

Blood pressure in the longevous population with different status of hypertension and frailty

Hypertension Research volume 47, pages 959–969 (2024)Cite this article

Abstract

Blood pressure(BP) of the longevous population with hypertension and/or frailty was under-investigated. To investigate the association between age, BP, variation of BP, and survival among the old adults with different status of hypertension and frailty, the present study included adults ≥65 years in the Chinese Longitudinal Healthy Longevity Survey (2008–2018), defined frailty using the Fried criteria, and identified hypertension by self-report or SBP/DBP ≥ 140/90 mm Hg. The association between age and BP were investigated using linear regression models. Variation of BP was defined if annual change of BP lower than quartile 1(sharp decrease) or higher than quartile 3(sharp increase). The association between age and BP variation were investigated using multinominal logistic regression models. The association between BP and survival was analyzed using Cox regression models. Among 13,447 adults (centenarian: 1965[14.6%]), age was positively associated with SBP in robust hypertensive elderly but negatively associated with it in frail hypertensive elderly. Annual change of BP was more likely to be increment among the normotensive elderly, but be decrement among the hypertensive elderly, especially among those with frailty. SBP < 120 mmHg was the risk factor of mortality among the frail oldest-old (≥85 years) while SBP ≥ 150 mmHg was that among the robust young-old (65–84 years). DBP ≥ 90 mmHg was the risk factor of mortality both in the robust young-old and the frail oldest old. In conclusion, age and frailty might be the criteria to predict the change of BP to guide the BP management of the longevous population.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available in the CLHLS repository, https://opendata.pku.edu.cn/dataverse/CHADS.

References

  1. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018;39:3021–104.

    Article  PubMed  Google Scholar 

  2. Whelton PK, Carey RM, Aronow WS, Casey DE Jr., Collins KJ, Dennison Himmelfarb C, 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. Hypertension 2018;71:e13–e115.

    CAS  PubMed  Google Scholar 

  3. Carey RM, Wright JT Jr., Taler SJ, Whelton PK. Guideline-driven management of hypertension: an evidence-based update. Circ Res. 2021;128:827–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. Wang HY, Lv X, Du J, Kong G, Zhang L. Age- and Gender-Specific Prevalence of Frailty and Its Outcomes in the Longevous Population: The Chinese Longitudinal Healthy Longevity Study. Front Med (Lausanne). 2021;8:719806.

  7. Qaseem A, Wilt TJ, Rich R, Humphrey LL, Frost J, Forciea MA, et al. Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: a clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians. Ann Int Med. 2017;166:430–7.

    Article  PubMed  Google Scholar 

  8. Benetos A, Bulpitt CJ, Petrovic M, Ungar A, Agabiti Rosei E, Cherubini A, et al. An expert opinion from the European Society of Hypertension-European Union Geriatric Medicine Society Working Group on the Management of Hypertension in Very Old, Frail Subjects. Hypertension 2016;67:820–5.

    Article  CAS  PubMed  Google Scholar 

  9. Benetos A, Petrovic M, Strandberg T. Hypertension management in older and frail older patients. Circ Res. 2019;124:1045–60.

    Article  CAS  PubMed  Google Scholar 

  10. Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res. 2019;42:1235–481.

    Article  PubMed  Google Scholar 

  11. Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, et al. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. J Am Med Dir Assoc. 2017;18:564–75.

    Article  PubMed  Google Scholar 

  12. Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodríguez-Mañas L, Fried LP, et al. Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. J Nutr Health Aging. 2019;23:771–87.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Parati G, Ochoa JE, Lombardi C, Bilo G. Assessment and management of blood-pressure variability. Nat Revi Cardiol. 2013;10:143–55.

    Article  Google Scholar 

  14. Rouch L, De Souto Barreto P, Hanon O, Vidal JS, Amar J, Andrieu S, et al. Visit-to-visit blood pressure variability and incident frailty in older adults. J Gerontol A Biol Sci Med Sci. 2021;76:1369–75.

    Article  PubMed  Google Scholar 

  15. Pimenta E, Oparil S. Management of hypertension in the elderly. Nat Rev Cardiol. 2012;9:286–96.

    Article  CAS  PubMed  Google Scholar 

  16. Zyczkowska J, Klich-Raczka A, Mossakowska M, Gasowski J, Wieczorowska-Tobis K, Grodzicki T. Blood pressure in centenarians in Poland. J Hum Hypertens. 2004;18:713–6.

    Article  CAS  PubMed  Google Scholar 

  17. Wang R, Vetrano DL, Liang Y, Qiu C. The age-related blood pressure trajectories from young-old adults to centenarians: A cohort study. Int J Cardiol. 2019;296:141–8.

    Article  PubMed  Google Scholar 

  18. Delgado J, Bowman K, Ble A, Masoli J, Han Y, Henley W, et al. Blood pressure trajectories in the 20 years before death. JAMA Int Med. 2018;178:93–99.

    Article  Google Scholar 

  19. Ravindrarajah R, Hazra NC, Hamada S, Charlton J, Jackson SHD, Dregan A, et al. Systolic blood pressure trajectory, frailty, and all-cause mortality >80 years of age: cohort study using electronic health records. Circulation 2017;135:2357–68.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Masoli JAH, Delgado J, Pilling L, Strain D, Melzer D. Blood pressure in frail older adults: associations with cardiovascular outcomes and all-cause mortality. Age Ageing. 2020;49:807–13.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM, et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial. JAMA 2016;315:2673–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. Treatment of hypertension in patients 80 years of age or older. N. Engl J Med. 2008;358:1887–98.

    Article  CAS  PubMed  Google Scholar 

  23. Center for Healthy Aging and Development Studies. The Chinese Longitudinal Healthy Longevity Survey (CLHLS)-Longitudinal Data (1998–2018). V2 edn. Peking University Open Research Data Platform; 2020. https://opendata.pku.edu.cn/dataset.xhtml?persistentId=doi:10.18170/DVN/WBO7LK.

  24. Wang HY, Zhang M, Sun X. Sex-Specific Association Between Socioeconomic Status, Lifestyle, and the Risk of Frailty Among the Elderly in China. Front Med (Lausanne). 2021;8:775518.

  25. Zeng Y. Introduction to the Chinese Longitudinal Healthy Longevity Survey (CLHLS). 20. Dordrecht: Springer Netherlands; 2008. p. 23–38.

    Google Scholar 

  26. Lv YB, Gao X, Yin ZX, Chen HS, Luo JS, Brasher MS, et al. Revisiting the association of blood pressure with mortality in oldest old people in China: community based, longitudinal prospective study. BMJ 2018;361:k2158.

    Article  PubMed  PubMed Central  Google Scholar 

  27. D’Agostino RB, Belanger AJ, Kannel WB, Cruickshank JM. Relation of low diastolic blood pressure to coronary heart disease death in presence of myocardial infarction: the Framingham Study. BMJ 1991;303:385–9.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wang HY, Meng Q, Yang C, Wang Y, Kong G, Zhao Y, et al. Association between pulse pressure, systolic blood pressure and the risk of rapid decline of kidney function among general population without hypertension: results from the China health and retirement longitudinal study (CHARLS). J Trans Med. 2021;19:512.

    Article  Google Scholar 

  29. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–156.

    Article  CAS  PubMed  Google Scholar 

  30. Herr M, Jeune B, Fors S, Andersen-Ranberg K, Ankri J, Arai Y, et al. Frailty and associated factors among Centenarians in the 5-COOP countries. Gerontology 2018;64:521–31.

    Article  PubMed  Google Scholar 

  31. Wu C, Smit E, Xue QL, Odden MC. Prevalence and correlates of frailty among community-dwelling chinese older adults: the china health and retirement longitudinal study. J Gerontol A Biol Sci Med Sci. 2017;73:102–8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hanlon P, Nicholl BI, Jani BD, Lee D, McQueenie R, Mair FS. Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493 737 UK Biobank participants. Lancet Public Health. 2018;3:e323–e332.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Singh S, Bailey KR, Noheria A, Kullo IJ. Frailty across the spectrum of ankle-brachial index. Angiology 2012;63:229–36.

    Article  PubMed  Google Scholar 

  34. Abellan van Kan G, Rolland YM, Morley JE, Vellas B. Frailty: toward a clinical definition. J Am Med Dir Assoc. 2008;9:71–72.

    Article  PubMed  Google Scholar 

  35. Hajek A, Brettschneider C, Mallon T, Kaduszkiewicz H, Wiese B, Oey A, et al. Frailty and autonomy among the oldest old: evidence from the multicenter prospective AgeCoDe-AgeQualiDe Study. Gerontology 2021;67:591–8.

    Article  PubMed  Google Scholar 

  36. Valenzuela PL, Castillo-García A, Morales JS, Izquierdo M, Serra-Rexach JA, Santos-Lozano A, et al. Physical exercise in the oldest old. Compr Physiol. 2019;9:1281–304.

    Article  PubMed  Google Scholar 

  37. Oates DJ, Berlowitz DR, Glickman ME, Silliman RA, Borzecki AM. Blood pressure and survival in the oldest old. J Am Geriatr Soc. 2007;55:383–8.

    Article  PubMed  Google Scholar 

  38. Kaplan RC, Tirschwell DL, Longstreth WT Jr., Manolio TA, Heckbert SR, LeValley AJ, et al. Blood pressure level and outcomes in adults aged 65 and older with prior ischemic stroke. J Am Geriatr Soc. 2006;54:1309–16.

    Article  PubMed  Google Scholar 

  39. Weidung B, Boström G, Toots A, Nordström P, Carlberg B, Gustafson Y, et al. Blood pressure, gait speed, and mortality in very old individuals: a population-based cohort study. J Am Med Dir Assoc. 2015;16:208–14.

    Article  PubMed  Google Scholar 

  40. Brown IJ, Tzoulaki I, Candeias V, Elliott P. Salt intakes around the world: implications for public health. Int J Epidemiol. 2009;38:791–813.

    Article  PubMed  Google Scholar 

  41. Chen LK, Lee WJ, Peng LN, Liu LK, Arai H, Akishita M. Asian Working Group for Sarcopenia. Recent Advances in Sarcopenia Research in Asia: 2016 Update From the Asian Working Group for Sarcopenia. J Am Med Dir Assoc 2016;17:767.e1–e7.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

HYW: conceptualisation, formal analysis, funding acquisition, investigation, project administration, supervision, visualisation, writing – original draft, and writing—review & editing. JW: formal analysis, methodology, software, writing - review & editing. QW: validation, funding acquisition, writing—review & editing. CY: formal analysis, methodology, software, funding acquisition, writing—review & editing. YH: writing—review & editing. MC: conceptualisation, methodology, supervision, writing - review & editing.

Funding

Source of funding This study was supported by the National Natural Science Foundation of China (82100741, 82003529, 82200776). The funding sources did not involve in the study design, data analyses or interpretation, or writing.

Author information

Authors and Affiliations

  1. National Institute of Traditional Chinese Medicine Constitution and Preventive Treatment of Diseases, Beijing University of Chinese Medicine, Beijing, China

    Huai-Yu Wang

  2. Renal Division, Department of Medicine, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China

    Jinwei Wang, Chao Yang & Min Chen

  3. Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China

    Qin Wang

  4. First Nephrology Department, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise, Guangxi, China

    Yuming Huang

Authors
  1. Huai-Yu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jinwei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qin Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chao Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuming Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Min Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Huai-Yu Wang.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, HY., Wang, J., Wang, Q. et al. Blood pressure in the longevous population with different status of hypertension and frailty. Hypertens Res 47, 959–969 (2024). https://doi.org/10.1038/s41440-023-01499-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41440-023-01499-1

Keywords

This article is cited by

Search

Advanced search

Quick links