Effects of Intensive Blood Pressure Control in Patients With Frailty: A Post Hoc Analysis From ESPRIT
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
Methodological detailspost hoc analysis
- Post hoc analysis
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: A Post Hoc Analysis From ESPRIT. J Am Coll Cardiol. Published 15 October 2025. doi:10.
Summarised from the published abstract; every number is checked against it