背景:高血压和虚弱通常同时发生,在老年人群中表现出越来越高的患病率。在这项研究中,我们分析了老年高血压患者的虚弱状态以及他们之间的相互作用对死亡风险的影响.
方法:这项前瞻性队列调查研究包括2009年至2020年北京城市社区老年人的数据,采用整群随机抽样方法。参与者是在调查时年龄≥60岁的老年人,并且在调查地点居住>1年。调查变量包括与2009年基线调查期间评估的健康和虚弱状态相关的变量,以及与死亡相关的信息作为2020年的结果变量。此外,在基线时,我们使用虚弱指数(FI)模型来检测老年人的虚弱状况.进一步分析高血压患病率对年龄相关的虚弱变化以及不同程度的虚弱对死亡率的影响。最后,Cox回归和Kaplan-Meier曲线用于评估高血压和虚弱之间的相互作用对死亡风险的影响。
结果:最终,纳入1197名年龄在60至101岁之间的老年人(基线平均年龄:74.8±8.6岁)。其中,475人是男性(平均年龄:74.8±8.8岁),女性为722名(平均年龄:74.8±8.4岁)。在151个人中发现了脆弱,导致患病率为12.6%(151/1197),593例(患病率:49.5%[593/1197])。到2020年,共有443人死亡,死亡率为37.0%(443/1197)。此外,与没有高血压的老年人相比,有高血压的老年人在任何年龄的FI值和死亡率都较高。生存时间分析显示,患有高血压和虚弱的老年人的中位生存时间最短(39.0[95CI:35.6-42.3]个月),而没有高血压但虚弱的老年人的中位生存时间(52.9[95CI:46.6-59.3]个月)。那些有高血压但没有虚弱(102.7[95CI:98.7-106.8]个月),和那些没有高血压和虚弱(127.9[95CI:113.5-134.7]个月),对数秩x2=999.686,P<0.001。此外,Cox回归结果表明,与没有高血压和虚弱的老年人相比,有高血压和虚弱的老年人死亡风险最高(HR=1.792,P<0.001)。无高血压但体弱者(HR=1.484,P<0.001),和那些有高血压但没有虚弱的人(HR=1.406,P=0.005)。
结论:虚弱在老年高血压患者中普遍存在;然而,患有高血压和虚弱的老年人有相对较高的死亡风险.因此,筛查和评估老年高血压患者的虚弱对其早期识别至关重要,从而能够及时和适当的干预措施,以防止或延迟这种并发情况的不利影响。
BACKGROUND: Hypertension and frailty often occur concurrently, exhibiting increasing prevalence in the older population. In this
study, we analyzed the frailty status among older adults with hypertension and the impact of their interaction on death risk.
METHODS: This prospective cohort survey
study included data from older people in an urban community in Beijing collected between 2009 and 2020 using the cluster random sampling method. The participants were older adults who were ≥ 60 years old at the time of investigation and had lived at the place of investigation for > 1 year. The survey variables comprised those related to health and frailty status assessed during the 2009 baseline survey, along with death-related information as outcome variables in 2020. Additionally, a frailty index (FI) model was used to examine the frailty status among the older adults at baseline. The effects of hypertension prevalence on the age-related frailty changes as well as on mortality for varying degrees of frailty were further analyzed. Lastly, Cox regression and Kaplan-Meier curves were applied to evaluate the impact of the interaction between hypertension and frailty on death risk.
RESULTS: Ultimately, 1197 older individuals aged between 60 and 101 years(average age at baseline: 74.8 ± 8.6 years) were included .Among them, 475 individuals were men (mean age:74.8 ± 8.8 years), and 722 were women (mean age:74.8 ± 8.4 years).Frailty was identified in 151 individuals, leading to a prevalence rate of 12.6%(151/1197),while hypertension was detected in 593 (prevalence rate:49.5% [593/1197]).A total of 443 deaths were recorded by 2020, resulting in a mortality rate of 37.0% (443/1197).Moreover, FI values and mortality rates were higher at any age in older adults with hypertension compared with those without hypertension. Survival time analysis showed that the median survival time of older adults with hypertension and frailty was the shortest (39.0[95%CI: 35.6-42.3] months)when compared with that of older adults without hypertension but with frailty (52.9 [95%CI: 46.6-59.3] months), those with hypertension but without frailty (102.7 [95%CI: 98.7-106.8] months), and those without hypertension and frailty (127.9 [95%CI: 113.5-134.7] months),with log-rank x2 = 999.686 and P < 0.001. Furthermore, Cox regression results demonstrated that older adults with hypertension and frailty had the highest death risk when compared with that of older adults without hypertension and frailty (HR = 1.792, P < 0.001), those without hypertension but with frailty (HR = 1.484, P < 0.001), and those with hypertension but without frailty (HR = 1.406, P = 0.005).
CONCLUSIONS: Frailty is prevalent among older adults with hypertension; however, older adults with both hypertension and frailty have a relatively higher mortality risk. Therefore, screening and assessment of frailty in the older population with hypertension are crucial for its early identification, thereby enabling timely and appropriate interventions to prevent or delay the adverse effects of this concurrent condition.