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Relationship between changes in late-life blood pressure and the risk of frailty and mortality among older population in China: a cohort study based on CLHLS

Hypertension Research (2024)Cite this article

Abstract

The evidence regarding the effects of blood pressure changes on older individuals remains inconclusive, and the impact of frailty throughout the life course is not known. We investigated the associations of different change patterns of blood pressure during 3-year intervals with frailty and mortality. Participants included 7335 persons from 2008 to 2014 of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Change in blood pressure was calculated as the difference between follow-up and baseline. Frailty was evaluated using a 40-item frailty index. Mortality status was ascertained up to December 31, 2014. The mean age of participants was 82.6 ± 10.7 years. The optimal blood pressure level (SBP, 130–150 mmHg; DBP, 70–90 mmHg) was associated with the lowest risk of frailty while decreasing follow-up SBP and DBP were significantly correlated with frailty. Lower baseline blood pressure levels (SBP < 130 mmHg; DBP < 70 mmHg) were associated with decreased mortality risk when participants increased their blood pressure to optimal levels during follow-up SBP and DBP (0.78, 0.63–0.98), compared to maintaining a steady low SBP (< 130 mmHg) and DBP (< 70 mmHg). For those with DBP around 70–90 mmHg, decreasing follow-up DBP (< 70 mmHg) was associated with higher mortality (1.23, 1.07–1.42) compared to maintaining stable follow-up DBP (70–90 mmHg). These results remain significant after adjusting for frailty. Optimal blood pressure levels were associated with the lowest risk of frailty. The association between lower blood pressure and increased mortality risk persisted even after accounting for frailty.

We used a nationally representative longitudinal cohort study by using 2008–2014 of the Chinese Longitudinal Healthy Longevity in China. Change in blood pressure was calculated as the difference between follow-up and baseline. We investigated the associations of different change patterns of blood pressure during 3-year intervals with frailty and mortality.

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Data availability

The data used for this study are publicly available on the CLHLS website: https://opendata.pku.edu.cn/dataverse/CHADS (accessed on 21 June 2022).

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China

    Yana Chen, Yanfang Wang, Yan Xu, Shunyao Shi, Zhong Tian, Kexin Jiang, Lina Jin & Yuchun Tao

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Contributions

Yana Chen: formal analysis, visualization, writing—original draft; Yanfang Wang and Yan Xu: manuscript revision; Yuchun Tao: conceptualization, methodology, supervision, writing—review & editing; Zhong Tian: investigation, methodology; Kexin Jiang and Shunyao Shi: conceptualization, investigation, methodology; Lina Jin: conceptualization, methodology, supervision, writing—review & editing.

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Correspondence to Yuchun Tao.

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The CLHLS study received approval from the Biomedical Ethics Committee of Peking University (IRB00001052–13074), and all participants have provided written informed consent.

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Chen, Y., Wang, Y., Xu, Y. et al. Relationship between changes in late-life blood pressure and the risk of frailty and mortality among older population in China: a cohort study based on CLHLS. Hypertens Res (2024). https://doi.org/10.1038/s41440-024-01674-y

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