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  • Review Article
  • Review Series - Hypertension at the End of Life
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Hypertension, the decline of activities of daily living (ADL) and frailty

Hypertension Research volume 45, pages 629–634 (2022)Cite this article

Abstract

In older adults, functional decline, such as frailty and the need for nursing care, has a significant impact on quality of daily life (QOL) and life expectancy, and this is also true for older patients with hypertension. It has been shown that hypertensive patients with frailty or those in need of nursing care might be disadvantaged by conventional hypertension treatment according to the guidelines, while it is also known that inappropriate antihypertensive treatment may cause functional impairment. Therefore, in the management of older hypertensive patients, it is important to understand a patient’s condition using functional assessments, such as a comprehensive geriatric assessment (CGA) or frailty assessments, and it is strongly recommended to determine the antihypertensive target and select the antihypertensive treatment according to the degree of functional impairment or frailty.

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References

  1. 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:M146–56.

    Article  CAS  Google Scholar 

  2. Satake S, Shimada H, Yamada M, Kim H, Yoshida H, Gondo Y, et al. Prevalence of frailty among community-dwellers and outpatients in Japan as defined by the Japanese version of the Cardiovascular Health Study criteria. Geriatr Gerontol Int. 2017;17:2629–34.

    Article  Google Scholar 

  3. Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal 2001;1:323–36.

    Article  CAS  Google Scholar 

  4. Warwick J, Falaschetti E, Rockwood K, Mitnitski A, Thijs L, Beckett N, et al. No evidence that frailty modifies the positive impact of antihypertensive treatment in very elderly people: an investigation of the impact of frailty upon treatment effect in the HYpertension in the Very Elderly Trial (HYVET) study, a double-blind, placebo-controlled study of antihypertensives in people with hypertension aged 80 and over. BMC Med. 2015;13:78.

    Article  Google Scholar 

  5. 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  Google Scholar 

  6. Pajewski NM, Williamson JD, Applegate WB, Berlowitz DR, Bolin LP, Chertow GM, et al. Characterizing frailty status in the systolic blood pressure intervention trial. J Gerontol A Biol Sci Med Sci. 2016;71:649–55.

    Article  Google Scholar 

  7. Rockwood K, Andrew M, Mitnitski A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci. 2007;62:738–43.

    Article  Google Scholar 

  8. Benetos A, Labat C, Rossignol P, Fay R, Rolland Y, Valbusa F, et al. Treatment with multiple blood pressure medications, achieved blood pressure, and mortality in older nursing home residents: the PARTAGE Study. JAMA Intern Med. 2015;175:989–95.

    Article  Google Scholar 

  9. Stessman J, Bursztyn M, Gershinsky Y, Hammerman-Rozenberg A, Jacobs JM. Hypertension and Its treatment at age 90 years: is there an association with 5-year mortality? J Am Med Dir Assoc. 2017;18:e13–e19. 277

    Article  Google Scholar 

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

    Article  Google Scholar 

  11. Kabayama M, Kamide K, Gondo Y, Masui Y, Nakagawa T, Ogawa M, et al. The association of blood pressure with physical frailty and cognitive function in community-dwelling septuagenarians, octogenarians, and nonagenarians: the SONIC study. Hypertens Res. 2020;43:1421–9.

    Article  Google Scholar 

  12. Todd OM, Wilkinson C, Hale M, Wong NL, Hall M, Sheppard JP, et al. Is the association between blood pressure and mortality in older adults different with frailty? A systematic review and meta-analysis. Age Ageing. 2019;48:627–35.

    Article  Google Scholar 

  13. Tabara Y, Kohara K, Ochi M, Okada Y, Ohara M, Nagai T, et al. Association of office-based frailty score with hypertensive end organ damage in the J-SHIPP cross-sectional study. Int J Cardiol. 2016;216:25–31.

    Article  Google Scholar 

  14. Wu C, Smit E, Peralta CA, Sarathy H, Odden MC. Functional status modifies the association of blood pressure with death in elders: health and retirement study. J Am Geriatr Soc. 2017;65:1482–9.

    Article  Google Scholar 

  15. Hozawa A, Okamura T, Murakami Y, Kadowaki T, Okuda N, Takashima N, et al. High blood pressure in middle age is associated with a future decline in activities of daily living. NIPPON DATA80. J Hum Hypertens. 2009;23:546–52.

    Article  CAS  Google Scholar 

  16. Canavan M, Smyth A, Bosch J, Jensen M, McGrath ER, Mulkerrin EC, et al. Does lowering blood pressure with antihypertensive therapy preserve independence in activities of daily living? A systematic review. Am J Hypertens. 2015;28:273–9.

    Article  Google Scholar 

  17. 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: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:1269–324.

    Article  CAS  Google Scholar 

  18. 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: 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;36:1953–2041.

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  20. 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  Google Scholar 

  21. Bromfield SG, Ngameni CA, Colantonio LD, Bowling CB, Shimbo D, Reynolds K, et al. Blood pressure, antihypertensive polypharmacy, frailty, and risk for serious fall injuries among older treated adults with hypertension. Hypertension. 2017;70:259–66.

    Article  CAS  Google Scholar 

  22. Mol A, Slangen LRN, Trappenburg MC, Reijnierse EM, van Wezel RJA, Meskers CGM, et al. Blood pressure drop rate after standing up is associated with frailty and number of falls in geriatric outpatients. J Am Heart Assoc. 2020;9:e014688.

    Article  Google Scholar 

  23. Butt DA, Mamdani M, Austin PC, Tu K, Gomes T, Glazier RH. The risk of hip fracture after initiating antihypertensive drugs in the elderly. Arch Intern Med. 2012;172:1739–44.

    Article  Google Scholar 

  24. 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;43:1352–60.

    Article  Google Scholar 

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Authors and Affiliations

  1. General and Geriatric Medicine, Kawasaki Medical School, Okayama, Japan

    Ken Sugimoto

  2. Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan

    Koichi Yamamoto

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  1. Ken Sugimoto
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  2. Koichi Yamamoto
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Correspondence to Ken Sugimoto.

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Sugimoto, K., Yamamoto, K. Hypertension, the decline of activities of daily living (ADL) and frailty. Hypertens Res 45, 629–634 (2022). https://doi.org/10.1038/s41440-021-00846-4

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