Relationship Between Blood Pressure And Adverse Event In Frailty Elderly:A Systematic Review And Meta-analysis

Background: Whether the effect of blood pressure(BP)on adverse events differs by frail status in the elderly is uncertain.This review aimed to investigate whether the association of BP with major adverse cardiovascular events(MACEs)is modified by frailty status.Methods: Electronic databases were searched up to June 2018,for randomized controlled trials or prospective cohort studies investigating BP and MACE in elderly under different health status.The primary outcome was MACEs included all-cause mortality,cardiovascular mortality,myocardial infarction and stroke.Two reviewers independently evaluated literature,assessed risk of bias and extracted data of included studies.All statistical analyses were performed using STATA 14.0 software.Results: Fifteen studies with 175759 individuals were included in the meta-analysis.The mean baseline BP of participants was between 131 and 158 mm Hg for systolic blood pressure(SBP)and between 68 and 84 mm Hg for diastolic blood pressure(DBP).The mean or median duration of follow-up was from 4 to 14 years.Among old adults aged ≤80 years,elevated SBP was associated with an increased risk of MACEs in non-frail individuals(HR=1.09,95%CI=1.02-1.17).In frail individuals,the risk of MACEs decreased with every 10 mm Hg increment in the DBP(HR=0.93,95%CI=0.88-0.98).However,there was no significant association between higher BP with MACEs in adults aged >80 years.Conclusion: the traditional cardiovascular risk was not associated with MACEs in very old population.Lower SBP is related to a decreased risk of MACEs among non-frail elderly aged ≤80 years.But low diastolic BP may be a marker of increased MACEs risk in frail elderly.