BLOOD PRESSURE VARIABILITY AND FRAILTY IN THE OLDER PEOPLE: THE HYPER-FRAIL-BPV STUDY

Objective: Blood pressure (BP) exhibits considerable variability that tends to increase with age. Frailty is a geriatric syndrome characterized by a reduction in physiological functional reserve and ability to maintain homeostasis, resulting in an increased vulnerability to adverse events. Frailty prevalence increases with age therefore BP variability (BPV) can be significantly increased in older frail patients. Nevertheless, the management of hypertension in older and frail patients has received little attention in the literature and represents an unresolved clinical question. We aimed to evaluate short term BPV in a cohort of elderly hypertensive patients and evaluate its association with frailty. Design and method: In this monocentric cross-sectional study we recruited hypertensive patients aged 75 years or older, evaluated at the Hypertension Center of Istituto Auxologico italiano IRCCS from May 2022 to August 2023. All patients underwent 24-hour blood pressure monitoring and a comprehensive geriatric assessment. Frailty was assessed through the Frailty Index (FI) according to the Rockwood's accumulation model. Based on the FI patients were classified as Fit (FI < 0.15), Pre-Frailty (0.15 < FI < 0.25) or Frailty (FI > 0.25). Results: 131 patients were recruited and a total of 106 patients were analysed because of missing data. The median age was 80 years [76-83], included patients were predominantly females (73%). Overall, 23 were fit, 50 in the pre-frailty category and 33 were frail. For each of the 7 systolic BPV indices considered, we fitted a multivariable linear model to estimate their relationship with continuous FI adjusting for age, sex, BMI, short physical performance battery, mini mental state examination, presence of falls in the last year, median 24h systolic blood pressure, mean diastolic 24h blood pressure and mean 24h heart rate. A significant positive association was observed only for SD night as depicted in Table 1. Conclusions: Nighttime BPV was associated with frailty in a cohort of elderly hypertensive subjects. The mechanisms behind this association and its impact on cardiovascular risk stratification in elderly patients should be further investigated.