Table 2.

Hypertension guidelines that mention frailty.

Author	Country	Association/Society	Frailty defined	Blood pressure threshold for frail older adultsa	Blood pressure target for frail older adultsa	Recommendationb/level of evidencec	Quality of guidelined
Feitosa 2019 [89]	Brazil	Brazilian Society of Cardiology and Brazilian Geriatrics and Gerontology Society	yes	Did not indicate	Adapted	Considered treatment of choicee/C	low
Hua 2019 [90]	China	Hypertension Branch of Chinese Geriatrics Society, National Clinical Research Centre of the Geriatric Diseases–Chinese Alliance of Geriatric Cardiovascular Disease	yes	≥ 160/90 mmHg	130–150 mmHg (systolic)	Should be considered/C	low
Kinoshita 2017 [91]	Japan	Japan Atherosclerosis Society	yes	Did not indicate	Did not indicate	Not given	low
Lee 2019 [92]	South Korea	Korean Society of Hypertension	no	>160 mmHg (systolic)	Did not indicate	Should be performed/A	low
Liu 2018 [93]	China	Chinese Hypertension League, Chinese Society of Cardiology, Hypertension Committee of the Chinese Medical doctor Association, Hypertension Branch of the China Association for the Promotion of International Exchanges of Health Care and Hypertension Branch of the Chinese Geriatrics Society	no	Adapted	Adapted	Not given	low
Malachias 2016 [94]	Brazil	Brazilian Society of Cardiology, Brazilian Society of Hypertension and Brazilian Society of Nephrology	no	Did not indicate	Adapted	Not given	low
Mallory 2014 [95]	Canada	Dalhouse Academic Detailing Service and the Palliative and Therapeutic Harmonization program	yes	≥160 mmHg	140–160 mmHg, severely frail 160–190 mmHg (systolic)	Not given	low
MsH, MOH 2018 [96]	Malaysia	Malaysian Society of Hypertension, Ministry of Health Malaysia, Academy of Medicine of Malaysia	yes	Did not indicate	Adapted	C	moderate - high
Nice 2019 [97]	UK	National Institute for Health and Care Excellence	yes	Adapted	Adapted	Not given	moderate - high
Piepoli 2016 [98]	Europe	European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice	no	Did not indicate	Adapted	May be considered/B (target)	moderate - high
Shah 2019 [99]	India	The Association of Physicians in India, Cardiological Society of India, Indian College of Physicians, Hypertension Society of India	no	Did not indicate	≥120/70 mmHg	Not given	low
SIGN 2017 [100]	Scotland	Scottish Intercollegiate Guidelines Network	no	Did not indicate	Adapted	Not given	moderate - high
Tay 2017 [101]	Singapore	Ministry of Health, Chapter of Family Medicine Physicians Academy of Medicine, Singapore, Chapter of Endocrinologists College of Physicians, Singapore, College of Family Physicians, Singapore, Singapore Hypertension Society	no	Did not indicate	Adapted	Af	low
Tykarski 2019 [102]	Poland	Polish Society of Hypertension	no	Adapted	Did not indicate	Not given	low
Umemura 2019 [103]	Japan	Japanese Society of Hypertension	yes	Adapted	Adapted	weak, C (target)	moderate - high
US Department of Defense 2020 [104]	USA	Department of Veteran Affairs and Department of Defense	no	Did not indicate	Adapted	Not given	moderate - high
Whelton 2017 [105]	USA	American College of Cardiology/American Heart Association Task Force	no	Adaptedg	Adaptedg	Can be beneficial, C	moderate - high
Williams 2018 [106]	Europe	European Society of Cardiology and European Society of Hypertension	no	Adapted	Adapted	May be considered/B3 (threshold)	moderate - high

^aUsed the term “adapted” to encompass the varying terminology used to indicate that recommendations can be modified for frailty/comorbidities without mentioning a specific threshold or target (eg, exceptions, individualized, use clinical judgment, consider benefits vs harm/clinical situation, etc.)

^bGuidelines provided either definition, level (strong, medium, high), and/or suggested wording for recommendation grade. For this table, used suggested wording as it is the most concise, and if this were not provided, then used level.

^cAll studies had the same basic levels of evidence, but the terminology used to describe the levels varied between studies. The one provided here is the version from Hau 2019. A: data derived from multiple randomized clinical trials or meta-analyses. B: data derived from a single randomized clinical trial or large non-randomized studies. C: consensus of opinion of the experts and or/small studies, retrospective studies, registries.

^dFrom Bogaerts et al. systematic review [88]. Assessed with AGREE 11 instrument.

^eFrom 2010 guideline as updated 2019; did not provide class of recommendation.

^fProvided recommendation grade as well (1+). However, the explanation of what each recommendation grade meant was unclear.

^gRecommendation appears to pertain only to a subset of frail older adults with a high burden of comorbidities, limited life expectancy, non-ambulatory and not living in the community.