BACKGROUND:Frailty frequently coexists with hypertension in older patients. We aimed to evaluate the association between frailty and positional change in blood pressure, especially orthostatic hypertension.METHODS:Participants were recruited from 12 University hospitals in South Korea. Using a digital device, trained research nurses measured blood pressure in the supine and standing positions. Physical frailty was evaluated using the Korean version of the FRAIL questionnaire, gait speed, and handgrip strength. Orthostatic hypertension was defined as a ≥20-mm Hg increase in systolic blood pressure within 3 minutes of standing and upright systolic blood pressure of ≥140 mm Hg.RESULTS:We analyzed the data of 2065 participants who had been enrolled until December 31, 2022. The mean age was 73.2±5.6 years, and 52.0% were female. The mean blood pressure was 137.1±14.9/75.1±9.7 mm Hg. Among the participants, 1886 (91.3%) showed normal response after standing, but 94 (4.6%) had orthostatic hypertension, and 85 (4.1%) had orthostatic hypotension. Orthostatic hypertension was associated with female sex, obesity, cognitive function, physical frailty, and lower quality of life. In the multivariable analysis, body mass index and frailty status were independently associated with orthostatic hypertension.CONCLUSIONS:Orthostatic hypertension is associated with physical frailty, cognitive impairment, and low quality of life in older patients with hypertension. Therefore, evaluation of orthostatic blood pressure changes to confirm orthostatic hypertension or hypotension in frail older adults will serve as an important diagnostic procedure in vulnerable patients. Further studies are required to identify the underlying mechanisms of this association.

中文翻译：

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体位性高血压与老年高血压患者虚弱之间的关系

背景：老年患者的虚弱常常与高血压同时存在。我们旨在评估虚弱与血压体位变化（尤其是直立性高血压）之间的关联。方法：从韩国 12 所大学医院招募参与者。训练有素的研究护士使用数字设备测量仰卧位和站立位的血压。使用韩国版FRAIL问卷、步态速度和握力来评估身体虚弱程度。直立性高血压定义为站立和直立收缩压≥140毫米汞柱后3分钟内收缩压增加≥20毫米汞柱。 结果：我们分析了截至2022年12月31日入组的2065名参与者的数据. 平均年龄为73.2±5.6岁，其中52.0%为女性。平均血压为137.1±14.9/75.1±9.7毫米汞柱。参与者中，1886 名（91.3%）站立后反应正常，但 94 名（4.6%）有直立性高血压，85 名（4.1%）有直立性低血压。直立性高血压与女性、肥胖、认知功能、身体虚弱和生活质量较低有关。在多变量分析中，体重指数和虚弱状态与直立性高血压独立相关。结论：直立性高血压与老年高血压患者的身体虚弱、认知障碍和生活质量低相关。因此，评估体弱老年人的直立性血压变化以确认直立性高血压或低血压将成为脆弱患者的重要诊断程序。需要进一步的研究来确定这种关联的潜在机制。