Frailty and sex differences in blood pressure control in older adults

We aimed to examine the prevalence of frailty in older adults with hypertension and its association with suboptimal blood pressure (BP), with a particular focus on differences by sex. The study was conducted at two major hospitals in Vietnam from 2023 to 2024. Frailty was defined by a Clinical Frailty Scale of ≥ 4. Suboptimal BP was defined as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg. There were 1038 participants (326 female, mean age 73 years). The prevalence of frailty was 28.6%, higher in female (35.3%) than male participants (25.6%). The overall rate of suboptimal BP was 26.7%. In female participants, the frail had a significantly higher rate of suboptimal BP (33.9%) compared to the non-frail (20.9%), but no significant differences among male. In the logistic model adjusted for age, education, marital status, physical exercise, falls, coronary heart disease, diabetes, chronic kidney disease, osteoarthritis, heart failure, stroke, atrial fibrillation, osteoporosis, chronic obstructive pulmonary disease, duration of hypertension, monotherapy/combination therapy, and medication adherence score, the odds ratios of frailty on suboptimal BP were 2.01 (95% CI 1.08–3.76) in female participants, 0.92 (95% CI 0.59–1.44) in male, female-to-male ratio of odds ratios 2.18 (95% CI 1.01–4.70). These findings highlight the need for sex-specific approaches in managing hypertension in older populations.