Skip to main content
Top
Published in: The journal of nutrition, health & aging 9/2018

01-11-2018

Variability in Repeated Blood Pressure Measurements as a Marker of Frailty

Authors: Jean Woo, R. Yu, K. Tsoi, H. Meng

Published in: The journal of nutrition, health & aging | Issue 9/2018

Login to get access

Abstract

Objectives

Variation in repeated blood pressure measurements may represent a decline in homeostatic mechanisms in blood pressure regulation in response to various internal or external stressors, indicating a frail state. We tested this hypothesis by examining the association between variability in repeated blood pressure measurements (BPV) and frailty status, adjusting for other confounding factors.

Design

A longitudinal cohort study.

Setting

Community centres in all three regions of Hong Kong.

Participants

1156 community-living older adults aged 60 years and over participated in a community geriatric screening program with blood pressure measurements three times a week over one year. Participants were divided into three groups based on variability of repeated blood pressure measurements (low, medium, high) using machine learning methods.

Measurements

Frailty status was assessed using the FRAIL scale. Logistic regression was used to examine cross sectional association between frailty status and BPV adjusting for confounding factors, and also frailty transition with BPV.

Results

In multi-variate models adjusting for co-variates, high BPV was associated with frailty (OR 1.57; 95% CI 1.05-2.37) among all participants; however, this was only significant in women in subgroup analysis. Similar findings were observed when transition to a more frail state was examined over a twelve month period.

Conclusions

The findings of this study support the concept of physiological dysregulation underlying the frail state, and that BPV calculated using machine learning methods may be used as a biomarker of such dysregulation.
Literature
1.
2.
go back to reference Varadhan R, Seplaki CL, Xue QL, Bandeen-Roche K, Fried LP. Stimulus-response paradigm for characterizing the loss of resilience in homeostatic regulation associated with frailty. Mech Ageing Dev 2008;129(11):666–70.CrossRefPubMedPubMedCentral Varadhan R, Seplaki CL, Xue QL, Bandeen-Roche K, Fried LP. Stimulus-response paradigm for characterizing the loss of resilience in homeostatic regulation associated with frailty. Mech Ageing Dev 2008;129(11):666–70.CrossRefPubMedPubMedCentral
3.
go back to reference Miller BF, Seals DR, Hamilton KL. A viewpoint on considering physiological principles to study stress resistance and resilience with aging. Ageing Res Rev 2017;38:1–5.CrossRefPubMed Miller BF, Seals DR, Hamilton KL. A viewpoint on considering physiological principles to study stress resistance and resilience with aging. Ageing Res Rev 2017;38:1–5.CrossRefPubMed
4.
go back to reference Walston JD. Conceptualizing frailty and resiliency and their physiological basis. Innovation in Aging 2017;1(S1):664.PubMedCentral Walston JD. Conceptualizing frailty and resiliency and their physiological basis. Innovation in Aging 2017;1(S1):664.PubMedCentral
6.
go back to reference Fried LP, Xue QL, Cappola AR, Ferrucci L, Chaves P, Varadhan R, et al. Nonlinear Multisystem Physiological Dysregulation Associated With Frailty in Older Women: Implications for Etiology and Treatment. Journals of Gerontology Series a-Biological Sciences and Medical Sciences 2009;64(10):1049–1057.CrossRef Fried LP, Xue QL, Cappola AR, Ferrucci L, Chaves P, Varadhan R, et al. Nonlinear Multisystem Physiological Dysregulation Associated With Frailty in Older Women: Implications for Etiology and Treatment. Journals of Gerontology Series a-Biological Sciences and Medical Sciences 2009;64(10):1049–1057.CrossRef
7.
go back to reference Li Q, Wang SR, Milot E, Bergeron P, Ferrucci L, Fried LP, et al. Homeostatic dysregulation proceeds in parallel in multiple physiological systems. Aging Cell 2015;14(6):1103–1112.CrossRefPubMedPubMedCentral Li Q, Wang SR, Milot E, Bergeron P, Ferrucci L, Fried LP, et al. Homeostatic dysregulation proceeds in parallel in multiple physiological systems. Aging Cell 2015;14(6):1103–1112.CrossRefPubMedPubMedCentral
8.
go back to reference Mitnitski A, Collerton J, Martin-Ruiz C, Jagger C, von Zglinicki T, Rockwood K, et al. Age-related frailty and its association with biological markers of ageing. Bmc Medicine 2015;13. Mitnitski A, Collerton J, Martin-Ruiz C, Jagger C, von Zglinicki T, Rockwood K, et al. Age-related frailty and its association with biological markers of ageing. Bmc Medicine 2015;13.
9.
go back to reference Rodriguez-Manas L. Contribution of the frailomic initiative to the biological understanding of frailty and resiliency. Innovation in Aging 2017;1(S1):665.CrossRefPubMedCentral Rodriguez-Manas L. Contribution of the frailomic initiative to the biological understanding of frailty and resiliency. Innovation in Aging 2017;1(S1):665.CrossRefPubMedCentral
10.
go back to reference Calvani R, Marini F, Cesari M, Tosato M, Picca A, Anker SD, et al. Biomarkers for physical frailty and sarcopenia. Aging Clinical and Experimental Research 2017;29(1):29–34.CrossRefPubMed Calvani R, Marini F, Cesari M, Tosato M, Picca A, Anker SD, et al. Biomarkers for physical frailty and sarcopenia. Aging Clinical and Experimental Research 2017;29(1):29–34.CrossRefPubMed
11.
go back to reference Giannattasio C, Ferrari AU, Mancia G. Alterations in Neural Cardiovascular Control Mechanisms with Aging. Journal of Hypertension 1994;12:S13–S17.CrossRefPubMed Giannattasio C, Ferrari AU, Mancia G. Alterations in Neural Cardiovascular Control Mechanisms with Aging. Journal of Hypertension 1994;12:S13–S17.CrossRefPubMed
12.
go back to reference Sabayan B, Wijsman LW, Foster-Dingley JC, Stott DJ, Ford I, Buckley BM, et al. Association of visit-to-visit variability in blood pressure with cognitive function in old age: prospective cohort study. Bmj-British Medical Journal 2013;347. Sabayan B, Wijsman LW, Foster-Dingley JC, Stott DJ, Ford I, Buckley BM, et al. Association of visit-to-visit variability in blood pressure with cognitive function in old age: prospective cohort study. Bmj-British Medical Journal 2013;347.
13.
go back to reference McAdams M, Ying H, Olorundare I, Gross A, Xue Q, Walston JD, et al. Frailty and the blood pressure response to the stressor of hemodialysis among older patients. Innovation in Aging 2017;1(S1):23.CrossRef McAdams M, Ying H, Olorundare I, Gross A, Xue Q, Walston JD, et al. Frailty and the blood pressure response to the stressor of hemodialysis among older patients. Innovation in Aging 2017;1(S1):23.CrossRef
14.
go back to reference Goh CH, Ng SC, Kamaruzzaman SB, Chin AV, Tan MP. Standing beat-to-beat blood pressure variability is reduced among fallers in the Malaysian Elders Longitudinal Study. Medicine 2017;96(42). Goh CH, Ng SC, Kamaruzzaman SB, Chin AV, Tan MP. Standing beat-to-beat blood pressure variability is reduced among fallers in the Malaysian Elders Longitudinal Study. Medicine 2017;96(42).
15.
go back to reference Cohen AA, Milot E, Li Q, Legault V, Fried LP, Ferrucci L. Cross-population validation of statistical distance as a measure of physiological dysregulation during aging. Experimental Gerontology 2014;57:203–210.CrossRefPubMedPubMedCentral Cohen AA, Milot E, Li Q, Legault V, Fried LP, Ferrucci L. Cross-population validation of statistical distance as a measure of physiological dysregulation during aging. Experimental Gerontology 2014;57:203–210.CrossRefPubMedPubMedCentral
16.
go back to reference Bangalore S, Fayyad R, Messerli FH, Laskey R, DeMicco DA, Kastelein JJP, et al. Relation of Variability of Low-Density Lipoprotein Cholesterol and Blood Pressure to Events in Patients With Previous Myocardial Infarction from the IDEAL Trial. American Journal of Cardiology 2017;119(3):379–387.CrossRefPubMed Bangalore S, Fayyad R, Messerli FH, Laskey R, DeMicco DA, Kastelein JJP, et al. Relation of Variability of Low-Density Lipoprotein Cholesterol and Blood Pressure to Events in Patients With Previous Myocardial Infarction from the IDEAL Trial. American Journal of Cardiology 2017;119(3):379–387.CrossRefPubMed
17.
go back to reference Rothwell PM, Howard SC, Dolan E, O’Brien E, Dobson JE, Dahlof B, et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 2010;375(9718):895–905.CrossRefPubMed Rothwell PM, Howard SC, Dolan E, O’Brien E, Dobson JE, Dahlof B, et al. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet 2010;375(9718):895–905.CrossRefPubMed
18.
go back to reference Woo J, Leung J. Multi-morbidity, dependency, and frailty singly or in combination have different impact on health outcomes. Age 2014;36(2):923–931.CrossRefPubMed Woo J, Leung J. Multi-morbidity, dependency, and frailty singly or in combination have different impact on health outcomes. Age 2014;36(2):923–931.CrossRefPubMed
19.
go back to reference Woo J, Yu R, Wong M, Yeung FN, Wong M, Lum C. Frailty Screening in the Community Using the FRAIL Scale. Journal of the American Medical Directors Association 2015;16(5):412–419.CrossRefPubMed Woo J, Yu R, Wong M, Yeung FN, Wong M, Lum C. Frailty Screening in the Community Using the FRAIL Scale. Journal of the American Medical Directors Association 2015;16(5):412–419.CrossRefPubMed
20.
go back to reference Buta BJ, Walston JD, Godino JG, Park M, Kalyani RR, Xue QL, et al. Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments. Ageing Research Reviews 2016;26:53–61.CrossRefPubMed Buta BJ, Walston JD, Godino JG, Park M, Kalyani RR, Xue QL, et al. Frailty assessment instruments: Systematic characterization of the uses and contexts of highly-cited instruments. Ageing Research Reviews 2016;26:53–61.CrossRefPubMed
21.
go back to reference Woo J, Goggins W, Sham A, Ho SC. Public health significance of the frailty index. Disability and Rehabilitation 2006;28(8):515–521.CrossRefPubMed Woo J, Goggins W, Sham A, Ho SC. Public health significance of the frailty index. Disability and Rehabilitation 2006;28(8):515–521.CrossRefPubMed
22.
go back to reference Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, et al. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. Journal of the American Medical Directors Association 2017;18(7):564–575.CrossRefPubMed Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, et al. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. Journal of the American Medical Directors Association 2017;18(7):564–575.CrossRefPubMed
23.
go back to reference Sinclair AJ, Abdelhafiz A, Dunning T, Izquierdo M, Rodriguez Manas L, Bourdel-Marchasson I, et al. An International Position Statement on the Management of Frailty in Diabetes Mellitus: Summary of Recommendations 2017. J Frailty Aging 2018;7(1):10–20.PubMed Sinclair AJ, Abdelhafiz A, Dunning T, Izquierdo M, Rodriguez Manas L, Bourdel-Marchasson I, et al. An International Position Statement on the Management of Frailty in Diabetes Mellitus: Summary of Recommendations 2017. J Frailty Aging 2018;7(1):10–20.PubMed
24.
go back to reference Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, et al. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol 2014;63(8):747–62.CrossRefPubMed Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, et al. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol 2014;63(8):747–62.CrossRefPubMed
25.
go back to reference Tse G, Gong M, Nunez J, Sanchis J, Li G, Ali-Hasan-Al-Saegh S, et al. Frailty and Mortality Outcomes After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2017;18(12):1097 e1–1097 e10.CrossRef Tse G, Gong M, Nunez J, Sanchis J, Li G, Ali-Hasan-Al-Saegh S, et al. Frailty and Mortality Outcomes After Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2017;18(12):1097 e1–1097 e10.CrossRef
26.
go back to reference Woo J, Leung J, Morley JE. Comparison of frailty indicators based on clinical phenotype and the multiple deficit approach in predicting mortality and physical limitation. J Am Geriatr Soc 2012;60(8):1478–86.CrossRefPubMed Woo J, Leung J, Morley JE. Comparison of frailty indicators based on clinical phenotype and the multiple deficit approach in predicting mortality and physical limitation. J Am Geriatr Soc 2012;60(8):1478–86.CrossRefPubMed
Metadata
Title
Variability in Repeated Blood Pressure Measurements as a Marker of Frailty
Authors
Jean Woo
R. Yu
K. Tsoi
H. Meng
Publication date
01-11-2018
Publisher
Springer Paris
Published in
The journal of nutrition, health & aging / Issue 9/2018
Print ISSN: 1279-7707
Electronic ISSN: 1760-4788
DOI
https://doi.org/10.1007/s12603-018-1082-9

Other articles of this Issue 9/2018

The journal of nutrition, health & aging 9/2018 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.