Predictors of long-term all-cause mortality and incident disability in older hypertensive outpatients.

OBJECTIVE

In previous studies involving older hypertensive adults, geriatric conditions with potential prognostic impact and outcomes of geriatric relevance (e.g., disability) remained largely unexplored. This study investigated predictors of all-cause mortality and incident disability in a real-world sample of older hypertensive outpatients undergoing comprehensive geriatric assessment.

METHODS

We analyzed data from the longitudinal HYPER-FRAIL pilot study, involving hypertensive outpatients ≥75 years undergoing comprehensive geriatric assessment, office, ambulatory and home blood pressure (BP) measurements. Predictors of long-term all-cause mortality and incident disability in basic activities of daily living (BADL) were assessed using multivariate Cox and logistic regression analyses, respectively.

RESULTS

Among 112 participants (mean age 81.2 years, 58% women, median follow-up 55 months), mortality was 25.9%. Baseline BADL disability, impaired physical performance and frailty independently predicted mortality. Stratified analyses showed that higher BP was associated with increased mortality risk only in patients with preserved autonomy in instrumental activities of daily living (IADL). Among those with IADL disability, office diastolic BP <80 mmHg and ambulatory 24 h systolic BP <130 mmHg were associated with increased mortality. Among 78 participants with baseline BADL autonomy, disability incidence was 39.7%. Predictors included baseline IADL and physical impairment, cognitive decline and ambulatory daytime hypotension. The association with hypotension was independent of falls or syncope, but not of dementia.

CONCLUSIONS

Disability, impaired physical performance and frailty predicted all-cause mortality in older hypertensive outpatients. The association between BP and mortality varied by functional status, suggesting a modifying - possibly reversing - effect. Ambulatory hypotension was associated with incident disability.

GRAPHICAL ABSTRACT: https://links.lww.com/HJH/D93.