Frailty and the relationship between blood pressure and mortality in elderly patients with type 2 diabetes (Zwolle Outpatient Diabetes project Integrating Available Care-34).
OBJECTIVE
We aimed to investigate whether adjustment for frailty influences the relationship of blood pressure with mortality in elderly patients with type 2 diabetes mellitus (T2DM).


METHODS
Patients aged 60 years and older (n = 858) were selected from a prospective observational cohort study of primary care patients with T2DM. Frailty was defined as a score less than 80 on the subscale 'physical functioning' of the RAND-36 questionnaire. After median follow-up for 14 years, multivariate Cox regression analyses were performed to evaluate the association between blood pressure and (cardiovascular) mortality. Analyses were performed in strata according to the frailty level ('physical functioning' score <80 and ≥80) and were repeated for patients older than 75 years.


RESULTS
Frailty was highly prevalent in our study population; 629 out of 858 patients (73%) fulfilled the criterion. For patients aged at least 60 years, the hazard ratios (95% confidence interval) of a 10 mmHg increase in SBP and DBP for cardiovascular mortality in nonfrail patients were 1.38 (1.15-1.68%) and 1.60 (1.07-2.37%), respectively. No relationship was observed for frail patients. For the oldest frail elderly, the hazard ratios of SBP and DBP for all-cause mortality were 0.92 (0.87-0.98%) and 0.83 (0.73-0.93%), respectively. For the oldest nonfrail elderly, a positive relationship between SBP and all-cause mortality was observed.


CONCLUSIONS
Frailty modifies the relationship between blood pressure and mortality in elderly patients with T2DM. Higher blood pressure was related to increased cardiovascular mortality in nonfrail patients, even in the oldest elderly, and to lower all-cause mortality in frail patients.
aDiabetes Centre, Isala, Zwolle bDepartment of General Practice cDepartment of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen dDepartment of Internal Medicine, Isala eLangerhans Medical Research Group, Zwolle fDepartment of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands.
Kornelis J J
KJ
van Hateren
Steven H
SH
Hendriks
Klaas H
KH
Groenier
Stephan J L
SJ
Bakker
Henk J G
HJ
Bilo
Nanne
N
Kleefstra
Gijs W D
GW
Landman
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005260:Female; D016330:Frail Elderly; D006304:Health Status; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires