HypertensionSecondary analysis
Effects of Intensive Blood Pressure Control in Patients With Frailty
- Secondary analysis of the ESPRIT randomised trial
- post hoc analysis
Authors' conclusion
Hypertensive patients with high cardiovascular risk benefit from the treatment strategy of targeting systolic BP <120 mm Hg, regardless of their frailty status. In addition, the effects of intensive treatment on experiencing adverse events did not differ by frailty status.
Study context
- Population
- Hypertensive patients at high CV risk in the ESPRIT trial, categorized by baseline frailty index (Rockwood cumulative deficit approach)
- Participants
- 11,255 patients
- Comparison
- Intensive blood pressure (BP) control vs standard treatment, by frailty status
- Nonfrailn = 4,366reference
- Moderately frailn = 5,257
- Severely frailn = 1,632
- Primary endpoint
- MACE (MI, hospitalization for HF, stroke or CV death), by frailty status
Primary result
As reported in the abstract
MACE, intensive vs standard treatment, by frailty level
Intensive treatment vs NonfrailRelative risk (95% CI)
nonfrail
0.84(0.65–1.08)
moderately frail
0.83(0.70–0.99)
severely frail
0.86(0.69–1.08)
Further findings
All-cause death, by frailty level
- Effects on all-cause death showed a similar pattern
Absolute risk reductions in major adverse cardiovascular events (MACE), CV death and all-cause death
- Greater absolute risk reductions with increasing frailty; interactions not significant
Effects across continuous frailty index (FI)
- Effects of intensive treatment consistent across the spectrum of continuous FI
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| Serious adverse events, by frailty level — Moderately frail vs Nonfrail | 1.32 (1.24–1.41) | |
| Serious adverse events, by frailty level — Severely frail vs Nonfrail | 1.68 (1.54–1.84) | |
| 0.512Hazard ratio (log scale) |
Serious adverse events, by frailty level
- None of the safety outcomes differed by frailty status
Original publication
Effects of Intensive Blood Pressure Control in Patients With Frailty. J Am Coll Cardiol. Published 15 October 2025. doi:10.1016/j.jacc.2025.08.092
Summarised from the published abstract; every number is checked against it