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Blood pressure satisfaction and antihypertensive medication adherence effects frailty transitions in older hypertensive patients

Hypertension Research (2026)Cite this article

Abstract

Studies on the effects of blood pressure (BP) control satisfaction and adherence to antihypertensive medication on frailty in older patients with hypertension are limited. We aimed to evaluate the effects of BP control satisfaction and antihypertensive medication adherence on frailty transitions. We obtained routinely collected data from the National Essential Public Health Service Package, involving community-dwelling older patients with hypertension from an administrative district in Shenzhen, China, from 2018 to 2022. BP control satisfaction and antihypertensive medication adherence scores were based on follow-up clinical assessments. The frailty index (FI) was evaluated by annual questionnaires and health examinations. Multi-state models were utilized to estimate the associations between BP control satisfaction and antihypertensive medication adherence scores with frailty transitions. The median age of the 10,391 patients was 70 years (interquartile range: 67–73) at baseline: 5062 (48.7%) were non-frail, 4726 (45.5%) were pre-frail, and 603 (5.8%) were frail. Over a median follow-up of 1.63 years, 5782 transitions were observed, with 2840 (49%) forward and 2942 (51%) backward transitions. High BP control satisfaction was associated with a lower likelihood of transitioning from a non-frail to a pre-frail or frail state. High antihypertensive medication adherence was associated with an increased risk of transitioning from a non-frail to a pre-frail state and impeded frailty reversion from the frail to the pre-frail state. Effective BP control has protective effects against the development of frailty, while antihypertensive medication adherence might have detrimental effects in community-dwelling older patients with hypertension; however, further studies are required to determine this effect.

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Acknowledgements

The authors thank the patients who joined the hypertension health service of the NEPHSP and the staff working in the primary healthcare centers who collected the data.

Funding

The work was supported by the Guangdong Basic and Applied Basic Research Foundation, China (grant no. 2022A1515110747, 2024A1515010973), the Shenzhen Medical Research Fund (B2303004), and the Sanming Project of Medicine in Shenzhen, China (SZSM202311001). The founders had no role in the design, analysis, or writing of this manuscript.

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Author notes

  1. These authors contributed equally: Gang Liu, Zhiqiang Ren.

Authors and Affiliations

  1. Shenzhen Center for Disease Prevention and Control, Shenzhen, China

    Gang Liu, Xuan Zou & Xiaoheng Li

  2. School of Medicine, Southern University of Science and Technology, Shenzhen, China

    Zhiqiang Ren & Wenjing Zhao

  3. School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China

    Zhiqiang Ren & Wenjing Zhao

  4. Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, China

    Jie Zhao

  5. Department of Outpatient Management, The University of Hong Kong – Shenzhen Hospital, Shenzhen, China

    Zeqian Zhang

  6. School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China

    Xudong Liu

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Correspondence to Xudong Liu or Wenjing Zhao.

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Liu, G., Ren, Z., Zhao, J. et al. Blood pressure satisfaction and antihypertensive medication adherence effects frailty transitions in older hypertensive patients. Hypertens Res (2026). https://doi.org/10.1038/s41440-025-02530-3

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