TOPLINE:

Among patients with hypertension, a frailty index more effectively identified the systolic blood pressure (BP) ranges associated with a lower risk for major adverse cardiovascular events (MACEs) than chronological age alone.

METHODOLOGY:

• Researchers pooled participant-level data from two major randomized controlled trials to evaluate whether a frailty index vs chronological age could better identify systolic BP targets in patients with hypertension.
• They included 19,230 participants, with a mean age of 65.2 years and 49.0% women. Of these, 10,378 were younger than 65 and 8852 were aged 65 years or older.
• Researchers used a validated 31-item Rockwood cumulative-deficit model to calculate the frailty index and classified patients with a score greater than 0.21 as having frailty (n = 13,118) and those with a score of 0.21 or less as not having frailty (n = 6112).
• The time-in-target range for systolic BP was defined as the proportion of follow-up time during which systolic BP of each participant remained within the specified 10-mm Hg intervals.
• The primary outcome was the first occurrence of MACEs, defined as a composite of myocardial infarction, stroke, or cardiovascular death.

TAKEAWAY:

• Researchers observed a J-shaped association between average systolic BP and the incidence of MACEs, with the lowest risk at 120-130 mm Hg and clearer separation by frailty than by chronological age. Participants with frailty consistently had higher incidence rates of MACEs than those without frailty at all systolic BP levels.
• Among participants with frailty, each 10% increase in the time spent within the systolic BP range of 110-140 mm Hg was associated with a lower risk for MACEs (hazard ratios [HRs], 0.92-0.94). Each 10% increase in the time spent above 140 mm Hg was linked to a higher risk (HRs, 1.11-1.17).
• In participants without frailty, each 10% increase in the time spent within the systolic BP range of 110-120 mm Hg was associated with a lower risk for MACEs (HR, 0.90); the risk was borderline lower at systolic BP level below 110 mm Hg but increased at 130 mm Hg or above (HRs, 1.07-1.21).
• Patients younger than 65 and those 65 or older had similar HRs across systolic BP bands, indicating limited discrimination by chronological age alone.

IN PRACTICE:

“Integration of FI [frailty index] into electronic health records and clinical decision-support systems may further enhance risk stratification and guide personalized SBP [systolic BP] goals,” the researchers of the study wrote.

SOURCE:

The study was led by Yizhen Lyu, Xi’an Jiaotong University Health Science Center in Xi’an, China. It was published online on March 6, 2026, in Hypertension.

LIMITATIONS:

The study used a 31-item frailty index harmonized across the two trials, rather than a single standardized frailty index; the cumulative deficit nature of the frailty index may have limited the feasibility of simplifying the index for routine clinical use. Exclusion of patients with certain high-risk conditions may have limited the generalizability. The pooled dataset had relatively few participants aged 80 years or older, which restricted the ability to evaluate guideline-defined distinctions between patients aged 65-79 and those aged 80 or older.

DISCLOSURES:

The study received funding from the National Natural Science Foundation of China. The authors did not declare having any conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.