A Vietnamese outpatient study suggests frailty may identify older women with hypertension who are more likely to have suboptimal blood pressure control, raising questions about how sex, aging, falls risk, and treatment decisions intersect in cardiovascular care.
Study: Frailty and sex differences in blood pressure control in older adults. Image Credit: Mykola Churpita / Shutterstock
A recent "Article in Press" in the journal Scientific Reports showed that frailty was more common among older women than among older men, while overall rates of suboptimal blood pressure (BP) were similar between the sexes. Frail women had approximately twice the odds of suboptimal BP. Such associations were not observed for men. These findings suggest the need for more personalized strategies for BP control, focusing on older women with frailty, while future studies assess whether frailty-informed BP management improves cardiovascular outcomes.
Hypertension is an established risk factor for cardiovascular disease. If left uncontrolled, hypertension can lead to severe heart and renal disease, and even dementia.
Clinicians are trying to manage hypertension; however, effective BP control remains a global challenge. Older adults are more likely to develop hypertension than the younger population. It is also more difficult to manage hypertension in older adults since many of them have multiple comorbid conditions, use several medications, and may have memory or thinking difficulties.
Frail adults may be at a higher risk since they often experience difficulty in taking their medications regularly, and their bodies may react differently to treatment. Previous studies have determined frailty prevalence among older adults, but those evaluating the association between frailty and BP control in older adults are limited.
About the Study
In this cross-sectional study, researchers investigated whether frailty and sex influence blood pressure regulation in older adults.
The team analyzed data of hypertensive adults aged ≥60 years attending outpatient clinics at two major hospitals in Vietnam between 2023 and 2024. These individuals had a physician-confirmed hypertension diagnosis documented in their health records and/or were currently using antihypertensive medications. The researchers obtained sociodemographic, anthropometric, and medical history data through health records and participant interviews.
The team assessed frailty using the Clinical Frailty Scale (CFS) score≥ 4.0. The thresholds for suboptimal BP control were systolic BP (SBP) ≥140 mmHg or diastolic BP (DBP) ≥90 mmHg. These thresholds were recommended by the 2022 Vietnamese Society of Hypertension Guidelines. These BP readings were collected during outpatient clinic visits and documented in participants’ health records in the previous six months. Home BP monitoring and ambulatory BP monitoring data were not systematically available.
The researchers used logistic regression models to calculate the odds ratios (ORs) for analysis. They adjusted for covariates such as age, level of education, physical exercise, marital status, falls, and comorbid conditions. These conditions included diabetes, chronic kidney disease, osteoporosis, osteoarthritis, chronic obstructive pulmonary disease (COPD), atrial fibrillation, coronary heart disease, stroke, heart failure, and hypertension duration. The team also adjusted for monotherapy, combination therapies, and treatment adherence.
Results and Discussion
The study included 1,038 older adults (mean age, 73 years, 326 women). Nearly half of the participants were living with conditions such as coronary heart disease (49%) or type 2 diabetes (44%). Hypertension treatment was largely similar for both sexes. On average, both women and men took about two to three blood pressure medications. The main difference was that women were somewhat less likely to be prescribed medications that target the renin–angiotensin–aldosterone system (RAAS). The proportion of men using combination therapies was significantly higher than among women.
In the sample population, most participants showed a CFS score of 3.0. The mean SBP and DBP values were 132 mmHg and 75 mmHg, respectively. About 29% of the participants were frail. Frailty was higher among females (35%) compared to males (26%). Nearly 27% of participants had BP in the suboptimal range. Overall, suboptimal BP rates were similar in women and men, at 25.5% and 27.2%, respectively. Frail female participants showed a significantly higher prevalence of suboptimal BP than their non-frail counterparts (34% vs. 21%).
The regression models showed that frailty was associated with a higher likelihood of suboptimal BP among women. In fact, frail women had about twice the odds of suboptimal BP control compared with women who were not frail (OR, 2.01). Men did not show such associations (OR, 0.92). The association between frailty and suboptimal BP was significantly stronger in women than in men (female-to-male ratio of ORs, 2.18).
Frailty can reduce physical activity, but it cannot fully account for the differences observed between women and men. Older women in the study were more likely to have osteoporosis and experience falls. Since too low BP can increase the risk of dizziness, falls, and fractures, doctors may have been less aggressive in lowering BP among women. Differences in how women's and men's bodies handle medications could also influence treatment outcomes. However, the authors noted that the available data could not separate biological sex from gender-related factors, such as education, caregiving roles, health literacy, and access to care.
Conclusions
In this study, frailty was associated with suboptimal BP among women; no significant association was observed among men. These findings suggest that older hypertensive adults should be routinely screened for frailty. Early identification of high-risk individuals could enable prompt treatment and better outcomes. However, because the study was cross-sectional and used retrospectively collected routine clinical BP records, it cannot prove that frailty caused poorer BP control.
Future studies could use prospective approaches and analyze laboratory test results to confirm the findings. Researchers should also explore whether educational attainment, socioeconomic status, and dietary intake could influence BP control in frail adults. Since participants were recruited from hospital outpatient clinics and had high rates of multimorbidity and polypharmacy, the findings may apply best to clinically complex older adults receiving specialist care rather than all community-dwelling older adults. Such investigations could inform policymakers and health bodies to develop more informed care strategies.
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