Association between Frailty and Mortality, Falls, and Hospitalization among Patients with Hypertension: A Systematic Review and Meta-Analysis

Table 1

Basic characteristics of the included studies.

Study (year)

Study design

Country

Setting

Sample size

Age (years)

Female (%)

Identification for hypertension

Frailty measurements

Frailty (%)

Follow-up period (years)

Outcome

Effect measure

Adjustment factors

NOS

Bromfield (2017) [28]

Longitudinal

United States

Community

5236

≥65

53.7

Taking antihypertensive drugs

Indicators of frailty^#

5.9

6.4

Injurious falls

HR

Age, sex, race, region of residence, education, income, cigarette smoking, statin use, osteoporosis use, benzodiazepines use, albumin to creatinine ratio, diabetes, history of heart disease, history of stroke, SBP, DBP, number of antihypertensive medication classes taken

8

Pajewski (2016) [29]

Longitudinal

United States

Hospital

9306

≥50

35.5

SBP within the range of 130–180, 130–170, 130–160, or 130–150 mmHg while being on no more than 0/1, 2, 3, or 4 antihypertensive drugs, respectively

36-item frailty index

27.6

2.6

Injurious falls; All-cause hospitalizations

HR

Age, sex, race/ethnicity, education, alcohol consumption, and treatment arm

7

Lina (2018) [30]

Longitudinal

China

Community

1111

≥60

53.3

mmHg or  mmHg or self-reported hypertension or receiving antihypertensive drugs

CGA

19.6

8.0

All-cause mortality

HR

Age, sex

7

Vaes (2017) [31]

Longitudinal

Belgium

Hospital

301

≥80

NA

mmHg

Groningen Frailty Indicator; frailty phenotype; frailty index

30.0

5.1

All-cause mortality; Cardiovascular mortality

HR

NA

8

Ying-Yi (2018) [32]

Longitudinal

China

Hospital

348

≥65

10.0

mmHg or  mmHg or receiving antihypertensive drugs

Frailty phenotype

38.1

0.4

All-cause hospitalizations; Hypertensive end-organ damage (^apresence of proteinuria)

HR, OR

Age, malnutrition, cognitive decline, polypharmacy, complication, orthostatic hypotension, proteinuria

7

Misis (2015) [33]

Longitudinal

Spain

Community

541

≥65

NA

mmHg

m/s

39.0

5.3

All-cause mortality

HR

NA

8

Tabara (2016) [34]

Cross-sectional

Japan

Community

560

≥45

NA

mmHg or  mmHg or taking antihypertensive drugs

Simple frailty score^#

12.1

NA

Hypertensive end-organ damage (^apresence of proteinuria, ^bWMH, or ^chigh BNP)

OR

Age, sex

7

^#The most severe group was frailty, whose data were compared with the nonfrailty group. Subgroup participant samples were obtained by contacting the corresponding author. ^aProteinuria was defined as  g/g creatinine or routine urine test showed positive urine protein. ^bThe presence of WMHs was defined as and/or (PVH was classified into five grades: grade 0, absent or only a “rim”; grade 1, limited lesion-like “caps”; grade 2, irregular “halo”; grade 3, irregular margins and extension into the deep white matter; and grade 4, extension into the deep white matter and subcortical portion; DSWMH was also classified into five grades: grade 0, absent; grade 1, ≤3 mm small foci and regular margins; grade 2, ≥3 mm large foci; grade 3, diffusely confluent; grade 4, extensive changes in the white matter). ^cHigh BNP was defined as  pg/ml. CGA: comprehensive geriatric assessment; SBP: systolic blood pressure; DBP: diastolic blood pressure; HR: hazard ratio; OR: odds ratio; NA: not applicable; BNP: B-type natriuretic peptide; WMH: white matter hyperintensity.