Changes in frailty, intensive blood pressure treatment, and risks of adverse clinical outcomes: a post hoc analysis of the SPRINT trial

作者：Xiaoyun Zhang, Xi Meng, Siyu Wang, Qiang Li, Yueyue Wang, Xiang Yu, Kan Wang, Xuan Zhao, Mian Li, Tiange Wang, Zhiyun Zhao, Jieli Lu, Min Xu, Jie Zheng, Yufang Bi, Yu Xu · 发表于：BMC Medicine · 年份：2025 · DOI：10.1186/s12916-025-04382-7 · 被引用次数：2 · 研究领域：Frailty in Older Adults、Nutrition and Health in Aging、Blood Pressure and Hypertension Studies

BACKGROUND: Frailty is becoming a common health issue and its status changes overtime. However, the impact of the frailty status changes on clinical outcomes is unknown. We aimed to evaluate the association between changes in frailty status and adverse clinical outcomes, and to determine whether the changes modify the effects of intensive blood pressure (BP) treatment. METHODS: Using frailty index (FI) defined by the Systolic Blood Pressure Intervention Trial (SPRINT), participants were categorized as frail (FI > 0.21) or robust (FI ≤ 0.21). Changes in frailty were evaluated by frailty status at baseline and at 12 months. Participants were categorized as stable-robust, robust-to-frail, frail-to-robust, and stable-frail. Outcomes included incident cardiovascular disease (CVD), all-cause mortality, and serious adverse events (SAEs). Cox proportional hazard models were used to evaluate the association between frailty changes and outcomes, and potential modifications of the changes on intensive BP-lowering treatment. RESULTS: Overall, 7924 eligible SPRINT participants were included. Compared with stable-robust participants, robust-to-frail participants had 70%, 103%, and 47% increased risks of CVD (hazard ratio [HR] = 1.70, 95% confidence interval [CI] 1.20-2.41), all-cause mortality (HR = 2.03, 95% CI 1.22-3.37), and SAEs (HR = 1.47, 95% CI 1.17-1.84), respectively. Compared with stable-frail participants, a 52% decreased risk of all-cause mortality (HR = 0.48, 95% CI 0.24-0.95)...