217 DO THE FRAIL EXPERIENCE ADVERSE EVENTS FROM INTENSIVE BLOOD PRESSURE CONTROL? FINDINGS FROM THE IRISH LONGITUDINAL STUDY ON AGEING(TILDA)

Abstract

Background: The 2018 ESC/ESH guidelines for the management of arterial hypertension in adults aged ≥65 years recommend a blood pressure (BP) treatment target of 130- 139/70-79 mmHg if tolerated. Randomised controlled trials have recommended lower BP. However, low BP may cause adverse outcomes, especially in the frail. We aimed to identify if older adults, frail and non-frail, in wave 1 of TILDA being treated intensely for hypertension experienced more adverse events by wave 2. Methods: Data from participants aged ≥65 years treated for hypertension in Wave 1 was analysed. Frail/non-frail was identified by Frailty Phenotype (FP) and the Clinical Frailty Scale (CFS).Two blood pressure thresholds defined intensive control:<130/70 and<110/70 mmHg. We formulated 16 baseline participant groups based on frailty-BP combinations. Outcomes at wave 2 were analysed with adjusted binary logistic regression models. Results: 1,920 participants at Wave 1 were aged ≥65 years and treated for hypertension. 1,229 participants had full BP/FP data, while 1,288 had complete BP/CFS data. The frail by FP with treated BP >130/70 or>110/70 had a statistically significant risk of new TIA or stroke byWave 2.The frail by CFS with treated BP >130/70 or>110/70 had a statistically increased risk of recurrent falls and/or fractures, as did the frail by FP with treated BP >110/70. FP with treated BP <130/70 was associated with new heart failure. None of the frail-BP groups was independently predictive of cognitive decline, myocardial infarction, syncope or hospitalization. For the non-frail-BP groups, there was no increased risk of any of the outcomes. Conclusion: Frail older adults treated to higher BP thresholds seemed to have more adverse short-term health outcomes compared to the frail treated more intensely. Overall, a BP of <130/70 did not seem associated with more adverse outcomes. This 2-year prospective study's results of a community-dwelling cohort may not be generalisable to clinical populations.