Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence.
Section of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza, Molinette, Turin, Italy.
J Hypertens. 2024 Jan 1;42(1):86-94. doi: 10.1097/HJH.0000000000003559. Epub 2023 Oct 3.
To date, few studies have investigated frailty in hypertensive individuals. This study aimed at identifying the prevalence of frailty in a sample of hypertensive older outpatients using six different identification tools. Clinical correlates of frailty and agreement between different frailty definitions were also investigated.
The HYPER-FRAIL pilot study recruited hypertensive patients aged at least 75 years from two geriatric outpatient clinics of Careggi Hospital, Florence, Italy. Four frailty scales [Fried Frailty Phenotype, Frailty Index, Clinical Frailty Scale (CFS), Frailty Postal Score] and two physical performance tests [Short Physical Performance Battery (SPPB) and usual gait speed] were applied. The Cohen's kappa coefficient was calculated to assess agreement between measures. Multiple logistic regression was used to identify clinical features independently associated with frailty.
Among 121 participants (mean age 81, 60% women), frailty prevalence varied between 33 and 50% according to the tool used. Moderate agreement was observed between Fried Frailty Phenotype, Frailty Index and SPPB, and between Frailty Index and CFS. Agreement was minimal or weak between the remaining measures (K < 0.60). Use of walking aids and depressive symptoms were independently associated with frailty, regardless of the definition used. Frailty correlates also included dementia, disability and comorbidity burden, but not office and 24-h blood pressure values.
Frailty is highly prevalent among older hypertensive outpatients, but agreement between different frailty tools was moderate-to-weak. Longitudinal studies are needed to assess the prognostic role of different frailty tools and their clinical utility in the choice of antihypertensive treatment.
迄今为止，很少有研究调查过高血压患者的衰弱情况。本研究旨在使用六种不同的识别工具，确定高血压老年门诊患者样本中的衰弱发生率。还研究了衰弱的临床相关性以及不同衰弱定义之间的一致性。
HYPER-FRAIL 试点研究从意大利佛罗伦萨 Careggi 医院的两个老年门诊诊所招募了至少 75 岁的高血压患者。应用了 4 种衰弱量表[衰弱表型、衰弱指数、临床虚弱量表（CFS）、虚弱邮政评分]和 2 种身体表现测试[简短身体表现测试（SPPB）和常规步行速度]。计算 Cohen 的 kappa 系数以评估措施之间的一致性。使用多变量逻辑回归确定与衰弱独立相关的临床特征。
在 121 名参与者中（平均年龄 81 岁，60%为女性），根据所使用的工具，衰弱的患病率在 33%至 50%之间。在 Fried 衰弱表型、衰弱指数和 SPPB 之间以及在衰弱指数和 CFS 之间观察到中度一致性。在其余测量之间观察到一致性最小或较弱（K<0.60）。无论使用何种定义，使用助行器和抑郁症状与衰弱独立相关。衰弱的相关因素还包括痴呆、残疾和合并症负担，但不包括诊室和 24 小时血压值。
衰弱在老年高血压门诊患者中非常普遍，但不同衰弱工具之间的一致性为中度至弱。需要进行纵向研究，以评估不同衰弱工具的预后作用及其在选择抗高血压治疗中的临床实用性。
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