| ?Background?With the aging population,frailty has become a hot topic in the study of elderly health.Frailty is associated with hypertension in the elderly and may increase the risk of adverse events such as cardiovascular and cerebrovascular diseases and all-cause death,and seriously affect the quality of life in the elderly patients.The elderly hypertensive population has its own particularities and there are some uncertainties in antihypertensive treatment.Some study paid more attention to the regulation of blood pressure target in elderly hypertensive with frailty.There are few studies on abnormal blood pressure fluctuation and target organ protection for frail patients.Domestic research on Frailty has started late,frailty assessment have not attracted enough attention,and relevant epidemiological survey data are lacking.Therefore,our study focuses on the relationship between frail epidemiological characteristics and frailty and blood pressure changes,target organ damage,and short-term adverse prognosis in hospitalized elderly hypertensive patients.?Objective? 1.To assess the prevalence and risk factors of frailty with in elderly hypertensives;2.To investigate the relationship between frailty and blood pressure changes in elderly hypertensives;3.To investigate the relationship between frailty and target organ damage in elderly hypertensives;4.Discuss the relationship between frailty and re-hospitalized events;?Method?Object :This study was conducted from May 1,2017 to December 31,2017 to elderly patients with hypertension in the Department of Geriatrics of Guangzhou General Hospital of the Guangzhou Military Command(age?65 years)and completed the Fried Scale,MMSE,MNA-SF assessment.Methods: Collection of epidemiological data,blood biochemical tests,and 24-hour ambulatory blood pressure tests.Follow-up to March 1,2018,make sure whether short-outcomes occurred during follow-up(by medical records and annual telephone follow-up).Statistical Methods: SPSS 22 software was used for statistical analysis.Measured data were expressed as mean±standard deviation.Count data were expressed as percentages;t-test and chi-square test were used for comparison between groups.Non-conditional logistic regression analysis of the risk factors for frailty.Sperman rank correlation,linear regression,and multivariate logistic regression were used to analyze the relationship between Frailty and blood pressure changes and target organ damage.Finally,the cox regression model was used to analyze the relationship between frailty and re-admission events;p<0.05 was considered statistically significant.?Result? 1.The prevalence and risk factors of frailty: 2.1.1 The prevalence of frailty: A total of 348 elderly patients with hypertension were enrolled(men: 314 patients;women: 34 patients),including 130patients(37.4%)were frailty and 218 patients(62.6%)in the non-frailty.The age of the enrolled population was between 65 and 98 years old,with an average age of(84.53±7.48)years.The average age of the frailty group was(88.88±3.77)years.The rate of frailty in the young(<80 years old)group was 7.5%,and the rate of frailty in the elderly(?80 years old)group was 44.3%.There was a statistically significant difference in the deceased detection rate between the young and old age groups.(p<0.001).1.2 Comparison of General Baseline Information:Age,MNA-SF scores,MMSE scores,number of medications,and number of comorbidities were different between the frailty group and the non-failing group.Compared with the non-frail group,patients in the frail group had malnutrition,decreased cognitive function,multiple medication,and multiple comorbidities(p<0.05).Among comorbidities,the incidence of coronary heart disease,cardiac insufficiency,chronic renal insufficiency,cerebrovascular disease,osteoporosis,anemia,Parkinson's disease,and chronic obstructive pulmonary disease in the frailty group was high(p<0.05).1.3 The risk factors of frailty : Multivariate logistic regression models revealed that age,malnutrition,cognitive decline,cardiac insufficiency,and osteoporosis were related risk factors for frail hypertension in elderly patients(P<0.05).2.Relationship between frailty and blood pressure 2.1 Relationship between frailty and blood pressure severity: In different hypertension grading,as the grading is higher,the rate of frailty detection gradually increases,but the difference between the frailty group and the non-frailty group is not statistically significant(p>0.05).The 24-hour average blood pressure group analysis of the weak detection rate,the results showed that the systolic blood pressure was controlled at 120-139 mmHg,the weaker detection rate was lower than the level of ?160mmHg and <120mmHg(the difference was statistically significant p<0.05).2.2 Relationship between frailty and blood pressure variability: There was no significant difference in 24-hour short-term blood pressure variability(SD/CD/VIM)between frailty and non-frailty,and there was no difference in correlation between frailty and short-term 24-hour BP variability Statistical significance(p>0.05).2.3 Relationship between diurnal rhythm: There is an increase in nocturnal blood pressure in the frailty.Correlation analysis revealed that the frailty was positively correlated with night/day ratio(r=0.231,p<0.001)and negatively correlated with dipping rate(r=-0.243,p<0.001).The type of diurnal rhythm observed in the elderly hypertensive population was non-dipper and anti-dipper blood pressure(127 cases: 192 cases;36.5% vs 55.2%).The rate of anti-dipper blood pressure was also highest in frailty(70%,p<0.001).2.4 Relationship between frailty and morning blood pressure surge and orthostatic hypotension: frailty and morning blood pressure surge correlation(p>0.05).The rate of orthostatic hypotension in the frailty was high(41.5%,p=0.009).Logistic regression analysis found that frailty was associated with orthostatic hypotension(p=0.01,OR 1.191,95% CI(1.16,2.88)).Adjusting for age,the correlation difference was not statistically significant(p=0.155).3.Relationship between frailty and target organ damage 3.1 Relationship between frailty and heart damage: Left heart ejection fraction was lower in the frailty than in the non-frailty(P=0.002).The left ventricular mass index frailty group had a higher index than the non-frailty,but the difference was not statistically significant(p>0.05).Frailty was associated with left cardiac ejection fraction(p=0.05,OR 0.95,95% CI(0.92,0.98)).However,after adjusting for age,there was no significant difference in correlation(p=0.14).3.2 Relationship between frailty and renal damage: The positive rate of urinary protein and the incidence of eGFR decrease were higher in the frailty than in the non-frailty(21.5% vs 11.5%;37.7% vs 21.1%).The cystatin C and creatinine values were higher than those in the frailty(p<0.05).Frailty was associated with a decrease in urinary protein-positive,cystatin C,creatinine,and eGFR.With age correction,debility was associated with positive urinary protein(p=0.04,OR 2.03,95% CI(1.03,3.98)),and decreased eGFR(p=0.031,OR 1.32,95% CI(1.10,1.89)).3.1 Relationship between frailty and vascular lesions in the neck: The proportion of carotid atherosclerosis in this population is high(85.1%),and the proportion of carotid artery stenosis in the frailty group is higher than that in the non-frailty group.Frailty was associated with carotid artery stenosis(p=0.08,OR 13.26,95% CI(1.95,89.96)),and there was no significant difference in the correlation between frailty and age(p>0.05).3.1 Relationship between frailty and brain(vascular)damage: The proportion of patients with cerebral infarction is high(30.1%).Cerebral infarction in the frailty was higher than that in the nonfrailty(43.8% vs 22%,p<0.001).Cerebral infarction,TIA,lacunar infarction were association between frailty.After adjusting for age,cerebral infarction was found(p=0.001,OR 2.56,95% CI(1.43,4.56)),lacunar infarction(p=0.017,OR 2.39,95% CI(1.16,4.09))and frailty is closely related.4.Relationship between frailty and readmission: 4.1 Readmission: Average follow-up(139.6 ± 70.9)days,a total of 131 patients(37.6%)had re-admission to the hospital.The frail patients were admitted to the hospital more than nonfrail patients(50% vs 30.2%,p<0.05).The incidence of re-hospitalized events(cardiovascular events,cerebrovascular events,hypertension,infections,falls,all-cause deaths)was higher in the frailty than in the non-frail.4.2 Relationship between frailty and readmission events: Multivariate cox regression analysis found that frailty increased the risk of all-cause readmission in elderly hypertensive patients(p=0.048,HR 1.45,95% CI(1.003,2.095)).There was no statistically significant difference in readmission to cardiovascular and cerebrovascular events(p=0.399).?Conclusion? 1.Frailty is common in elderly hypertensive patients,and the prevalence of frailty increases with age.Age,malnutrition,decreased cognitive function,cardiac insufficiency,and osteoporosis history may be related risk factors for frailty in the elderly hypertensives.2.Frailty is associated with the nocturnal systolc BP in elderly hypertensive patients.3.Frailty is closely related to kidney damage and cerebrovascular damage in elderly hypertensive patients.4.Frailty may increase the total readmission risk of patients. |
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