Background Low blood pressure (BP) is associated with frailty in older adults. Our aim was to explore how BP predicts transitions between frailty states. Methods We used data from the Lausanne cohort Lc65+, a population-based cohort of older adults randomly drawn from a population registry in Switzerland, in 2004, 2009 and 2014. BP was measured using a clinically validated oscillometric automated device and frailty was defined using Fried’s phenotype, every 3 years. We used an illness-death discrete multi-state Markov model to estimate hazard ratios of forward and backward transitions between frailty states (outcome) in relation to BP categories (predictor of interest) with adjustment for sex, age and antihypertensive medication (other predictors). Results Among 4200 participants aged 65–70 years (58% female) at baseline, 70% were non-frail, 27% pre-frail and 2.0% frail. Over an average follow-up of 5.8 years, 2422 transitions were observed, with 1575 (65%) forward and 847 (35%) backward. Compared with systolic BP (SBP) <130 mmHg, the hazard ratio (95% confidence interval) of the transition from non-frail to pre-frail was 0.86 (0.74 to 1.00) for SBP 130–150 mmHg, and 0.89 (0.74 to 1.06) for SBP ≥150 mmHg. Compared with SBP <130 mmHg, the hazard ratio of the transition from pre-frail to frail was 0.71 (0.50 to 1.01) for SBP 130–150 mmHg, and 0.90 (0.62 to 1.32) for SBP ≥150 mmHg. Diastolic BP was a weaker predictor of forward transitions. Conclusions BP categories had no strong relationship with either forward transitions or backward transitions in frailty states. If our findings are confirmed with greater precision and assuming a causal relationship, they would suggest that there is no well-defined optimal BP level to prevent frailty among older adults.

中文翻译：

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在基于人群的队列研究中，血压如何预测老年人的虚弱转变：多状态转变模型

背景 低血压 (BP) 与老年人的虚弱有关。我们的目的是探索 BP 如何预测脆弱状态之间的转换。方法 我们使用了洛桑队列 Lc65+ 的数据，该队列是 2004 年、2009 年和 2014 年从瑞士人口登记处随机抽取的基于人群的老年人群。使用经过临床验证的示波自动设备测量血压，并使用 Fried's 定义虚弱表型，每 3 年一次。我们使用疾病-死亡离散多状态马尔可夫模型来估计与 BP 类别（感兴趣的预测因子）相关的衰弱状态（结果）之间的前向和后向转换的风险比，并调整性别、年龄和抗高血压药物（其他预测因子） . 结果 在 4200 名基线年龄在 65-70 岁（58% 女性）的参与者中，70% 没有体弱，27% 体弱前和 2.0% 体弱。在平均 5.8 年的随访中，观察到 2422 次转变，其中 1575 人（65%）向前，847 人（35%）向后。与收缩压 (SBP) <130 mmHg 相比，SBP 130-150 mmHg 从非衰弱到衰弱前转变的风险比（95% 置信区间）为 0.86（0.74 至 1.00），而 SBP 为 0.89（0.74）至 1.06) 对于 SBP ≥ 150 mmHg。与 SBP <130 mmHg 相比，SBP 130-150 mmHg 从衰弱前过渡到衰弱的风险比为 0.71（0.50 至 1.01），SBP ≥150 mmHg 为 0.90（0.62 至 1.32）。舒张压是前向转换的较弱预测因子。结论 BP 类别与虚弱状态下的前向转换或后向转换没有密切关系。如果我们的发现得到更精确的证实并假设存在因果关系，