Abstract
Background
Hypertension is one of the prominent modifiable risk factors for cardiovascular diseases (CVD), and its prevalence is continuously increasing each year, contributing significantly to mortality and disability in older adults in China and even worldwide. The aim of this study was to evaluate the impact of declined intrinsic capacity (IC) on the risk of 1-year functional disability in older hypertensive inpatients.
Methods
A total of 233 hypertensive elderly from Zhejiang Hospital in China were included in this retrospective observational study. Five domains of IC including cognition, locomotion, vitality, psychology, and sensory capacity were assessed at admission. Functional disability was defined as new dependencies in activities of daily living (ADL) over a 1-year follow-up period. Multivariate logistic regression models were used to investigate the relationships between IC domains at baseline and 1-year functional disability.
Results
The incidence of decline in five domains of IC, including cognition, locomotion, vitality, psychology, sensory (vision and hearing status) capacity were 28.8%, 55.8%, 27.9%, 12.4%, 42.9% and 63.1% respectively. Both systolic blood pressure (SBP) and pulse pressure (PP) were negatively linked to the IC composite score, and specifically with two domains of IC, including cognition and locomotion (P < 0.05). During the 1-year follow-up, 50 participants (21.5%) experienced functional disability. After adjusting for confounding factors, multivariate logistic regression analysis showed that a higher IC composite score on admission was associated with a lower one-year risk of functional disability (odds ratio [OR] = 0.57, 95% confidence interval [CI]: 0.40–0.80, P = 0.001); cognitive decline and locomotion impairment predicted 1-year functional disability in older hypertensive inpatients (OR = 3.08, 95% CI: 1.41–6.69, P = 0.005; OR = 3.35, 95% CI: 1.30–8.63, P = 0.012).
Conclusions
Declined cognition and locomotion increased the risk of functional disability 1 year after discharge, early prevention and management of declined intrinsic capacity is critically important among hypertensive elderly.
Keywords: Hypertension, Intrinsic capacity, Older adults, Functional disability
Background
Chronic non-communicable diseases (CNCDs), particularly cardiovascular diseases (CVD), have emerged as a significant global epidemic, posing a substantial public health challenge among older adults. CVD is a leading cause of death worldwide, with a report on the Cardiovascular Health and Diseases in 2022 highlighting that CVD accounted for a significant proportion of deaths (48.00% in rural areas and 45.86% in urban areas) in China alone [1]. Hypertension, a prominent modifiable risk factor for CVD, continues to rise in prevalence and significantly contributes to mortality and disability, both in China and worldwide [2–4].
Hypertensive patients, especially older adults, often present with complex clinical profiles including elevated systolic blood pressure (SBP), substantial blood pressure fluctuations, polypharmacy, and pseudo-hypertension [5–7]. Advancing age increases vulnerability to adverse effects of anti-hypertensive medications, particularly hypotension-related complications like falls, syncope, and fractures [8–10]. Consequently, hypertension guidelines emphasize the importance of considering the overall functional status, including frailty and cognitive function, when setting treatment goals for older adults prior to initiating anti-hypertensive medication [11–13]. This focus on functional status aligns closely with the concept of the World Health Organization's concept of intrinsic capacity (IC), a core element of healthy aging proposed in 2015 [14]. IC represents the sum of an individual's physical and mental capacities, which encompass cognitive function, psychological well-being, vitality, locomotion, and sensory abilities [14]. Importantly, a decline in IC is associated with several adverse health outcomes in older adults, including falls [15], frailty [16], disability [17, 18], hospital admissions [19, 20], and mortality [20, 21].
Given that hypertension can influence multiple functional domains, accumulating evidence has established links between blood pressure, its treatment, prognosis, and impairments across various IC dimensions. Data from the China Health and Retirement Longitudinal Study (CHARLS) revealed that untreated or uncontrolled hypertension is associated with worsened cognitive trajectories [22]. Depression frequently co-occurs with hypertension and may itself contribute to cardiovascular disease progression [23]. Hypertension adversely affects physical function, accelerating gait slowing in older adults; slow gait itself predicts poor prognosis in hypertensive patients [24, 25]. Sensory impairments, such as declines in hearing and vision, indicate hypertension-induced target organ damage [26]. Malnutrition, assessed using the Geriatric Nutrition Risk Index, predicts the risk of all-cause and cardiovascular mortality in older adults with hypertension [27]. Furthermore, a meta-analysis reveals that hypertension is a significant risk factor for IC decline in community elderly, affecting over two-thirds of community-dwelling older adults [28].
While available studies demonstrate that hypertension contributes to impairments in individual IC domains and predicts overall IC decline, they differ in methodologies and rarely examine the complex, multidirectional relationships between these domains. In addition, despite the established link between IC decline and disability [17, 18], and the known role of hypertension as a risk factor for both [28], there is a critical gap in understanding whether and how decline in overall IC and its specific domains influences the onset of functional disability specifically in older adults with hypertension [29].
Therefore, this study aims to examine the prevalence of declined IC and analyze its association with the onset of functional disability after one year in older adults with hypertension.
Methods
Participants
A retrospective cohort study was conducted at Zhejiang Hospital in China from October 2014 to July 2019. A total of 515 potential elderly inpatients were recruited and eventually 233 participants used for analysis in this study. The inclusion criteria were as follows: age ≥ 60 years, diagnosis of hypertension according to the Chinese Guidelines for Management of Hypertension, ability to walk independently or with walking aids, and ability to comprehend and communicate effectively. The exclusion criteria included non-hypertensive patients, acute medical conditions (e.g., acute cardiovascular and cerebrovascular diseases, acute infection), activities of daily living (ADL) scores below 60 on the Bath index [30], and lack of follow-up data.
This study was approved by the Medical Ethics Committee of Zhejiang Hospital (2013–25).
Baseline characteristics
Age, sex, body mass index (BMI), smoking history, and alcohol history were collected at baseline. More than or equal to 5 chronic diseases in an individual was defined as comorbidities [31]. Polypharmacy was considered as concomitant use of at least 5 oral medications daily [32, 33]. Hypertension duration, signifying cumulative exposure to elevated blood pressure, provides incremental prognostic value beyond current blood pressure measurements [34]. In this study, hypertension duration was categorized into clinically convenient groups (≤ 9, 10–19, and ≥ 20 years) to ensure sufficient functional disability incidences within each category. Hypertension stage was classified according to the 2018 Chinese Guidelines for Prevention and Treatment of Hypertension [35] (stage 1, stage 2, stage 3). Additionally, blood pressure control status, systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) were recorded.
IC assessment
In this study, five domains of IC were selected, including cognition, locomotion, vitality, psychology and sensory capacity. The Chinese version of the Mini-Mental State Examination (MMSE) was utilized to evaluate cognitive function [36]. A cut-off score of ≤ 24 was established to indicate cognitive decline. Locomotion was assessed through a four-meter gait speed test in which participants were instructed to walk twice their usual distance starting from a stationary position (walking aids or canes allowed). The recorded time for the shorter attempt was noted. The cut-off value for gait speed was established as < 1.0m/s, in accordance with the recommendations provided by the Asian Working Group for Sarcopenia (AWGS) [37]. Vitality was measured using the short-form Mini Nutritional Assessment (MNA-SF) [38], with scores ranging from 0 to 14 and a score ≤ 11 indicating risk of malnutrition. Psychological capacity was evaluated by assessing depressive symptoms through the 15-item Geriatric Depression Scale (GDS-15) [39], with a cut-off GDS-15 score ≥ 6 indicating poorer psychological performance. Self-reported vision and hearing status was used to ascertain sensory capacity, which was categorized as normal and impairment. Intrinsic capacity (IC) assessments were conducted by certified geriatric assessors. Qualified team members performed all evaluations following completion of a standardized training protocol. This protocol ensured consistent administration through detailed review of scoring criteria, supervised practice exercises, and formal qualification assessments.
Any decline in each IC domain was recorded as 0, otherwise it was recorded as [40]. The IC composite total score was calculated as the sum of the number of normal domains, with a range of 0 to 5 in this study. A higher IC composite score was indicative of a higher reserved functional capacity.
Functional disability assessment
Functional disability was defined as the emergence of new dependencies in activities of daily living (ADL) using the Bath index over a 1-year follow-up period. ADL performance was assessed by scoring each item according to the level of independence demonstrated by older adults. New ADL dependency was operationally defined as a decline of at least five points in the total ADL score one-year post-discharge among hospitalized elderly patients.
Data collection was performed by trained investigators using standardized protocols. To minimize bias, the investigator conducting the follow-up assessments was blinded to baseline data, follow-up was completed via structured telephone conversations or face-to-face interviews.
Statistical analysis
Data analysis was performed using SPSS 26.0 software (SPSS, Chicago, IL, USA). The proportion of missing data was below 10%, suggesting minimal impact on analytical validity and potential bias; consequently, incomplete cases were excluded from subsequent analyses. Normally distributed continuous variables are expressed as mean ± standard deviation (SD), non-normally distributed continuous variables as median and interquartile range (IQR), and categorical variables as frequencies and percentages. Group comparisons of baseline characteristics and IC domains employed Student's t-tests for normally distributed continuous variables, chi-square tests (or Fisher's exact tests where appropriate) for categorical variables, and Mann–Whitney U tests for non-normally distributed continuous variables. Variance inflation factors (VIF < 5) indicated no significant multicollinearity. Additionally, multivariable logistic regression models examined associations between baseline IC domains and one-year functional disability. Covariates were selected based on established confounding factors from literature and variables demonstrating significant associations (P < 0.05) in bivariate analyses. Results are presented as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Statistical significance was defined as P < 0.05.
Results
Our analysis included a total of 233 elderly hypertensive inpatients, the procedure of patient selection is detailed in Fig. 1. As shown in Fig. 2, the incidence of IC deficits in our study, including cognitive decline, locomotion impairment, malnutrition risk, depression, hearing and vision impairment, were 28.8%, 55.8%, 27.9%, 12.4%, 42.9% and 63.1% respectively. Notably, the incidence of cognitive decline, locomotion impairment, malnutrition risk, hearing impairment, and vision impairment demonstrated an age-dependent increase. In contrast, depressive symptoms showed no significant age-related increase in this hypertensive elderly population (Fig. 3).
Fig. 1.
The procedure of patient selection. Abbreviations: ADL, activities of daily living
Fig. 2.
The prevalence of IC domains in hypertensive inpatients
Fig. 3.
Prevalence and trend of IC domains by age
As detailed in Table 1, 50 elderly hypertensive inpatients (21.5%) experienced functional disability within 1 year of follow-up. Compared to patients who remained functionally independent, those developing new-onset functional disability were significantly older, had a lower proportion of married individuals, and exhibited higher percentages of comorbidities, polypharmacy, cognitive decline, locomotion impairment, malnutrition, alongside a lower IC composite score (all P < 0.05).
Table 1.
Comparing baseline characteristics and IC domains among patients with or without functional disability over one-year follow-up
| Total sample | Functional disability | P value | ||
|---|---|---|---|---|
| No (n = 183) | Yes (n = 50) | |||
| Baseline characteristics | ||||
| Age(years), median (IQR)a | 80(72–85) | 78(71–83) | 85(82–89) | < 0.001 |
| Male, n(%) | 135(57.9) | 107(58.5) | 28(56.0) | 0.754 |
| Married, n(%) | 181(77.7) | 148(80.9) | 33(66.0) | 0.025 |
| Current or former smokers, n(%) | 57(24.5) | 46(25.1) | 11(22.0) | 0.647 |
| Current or former drinkers, n (%) | 49(21.0) | 41(22.4) | 8(16.0) | 0.325 |
| Comorbidities (≥ 5 diseases), n(%) | 162(69.5) | 120(65.6) | 42(84.0) | 0.012 |
| Polypharmacy (≥ 5 medications), n(%) | 138(59.2) | 99(54.1) | 39(78.0) | 0.002 |
| BMI (kg/m2), mean ± SDb | 23.9 ± 3.2 | 23.9 ± 3.2 | 24.0 ± 3.3 | 0.730 |
| IC domains | ||||
| Cognitive decline, n(%) | 67(28.8) | 40(21.9) | 27(54.0) | < 0.001 |
| Locomotion impairment, n(%) | 130(55.8) | 87(47.5) | 43(86.0) | < 0.001 |
| Malnutrition risk, n(%) | 65(27.9) | 45(24.6) | 20(40.0) | 0.031 |
| Depression, n(%) | 29(12.4) | 19(10.4) | 10(20.0) | 0.068 |
| Hearing impairment, n(%) | 147(63.1) | 76(41.5) | 24(48.0) | 0.413 |
| Vision impairment, n(%) | 100(42.9) | 111(60.7) | 36(72.0) | 0.141 |
| IC composite score, median (IQR)a | 3(2–4) | 3(2–4) | 2(1–3) | < 0.001 |
Significance difference P < 0.05 was shown in bold. All data were analyzed by the chi-square test unless marked
Abbreviations: IC Intrinsic capacity, IQR Interquartile range, BMI Body mass index, MMSE Mini-mental state examination, MNA-SF The shortened mini nutritional assessment form, GDS Geriatric depression scale
athe Mann–Whitney U-test
bthe unpaired t-test
The comparison of hypertensive-related characteristics in this study revealed the median SBP was 140mmHg in participants with functional disability, higher than in those who maintained their function (134mmHg) (P < 0.05). However, no significant differences were observed between the groups regarding hypertension duration, hypertension stage, prevalence of uncontrolled hypertension, DBP and PP between two groups (Table 2).
Table 2.
Comparing hypertension correlated characteristics among patients with or without functional disability over one-year follow-up
| Total sample | Functional disability | P value | ||
|---|---|---|---|---|
| No (n = 183) | Yes (n = 50) | |||
| Hypertension duration, n(%) | 0.275 | |||
| ≤ 9 years | 76(32.6) | 55(30.1) | 21(42.0) | |
| 10–19 years | 68(29.2) | 55(30.1) | 13(26.0) | |
| ≥ 20 years | 89(38.2) | 73(39.9) | 16(32.0) | |
| Hypertension stage, n(%) | 0.185 | |||
| Stage 1 | 50(21.5) | 43(23.5) | 7(14.0) | |
| Stage 2 | 77(33.0) | 62(33.9) | 15(30.0) | |
| Stage 3 | 106(45.5) | 78(42.6) | 28(56.0) | |
| Uncontrolled hypertension, n(%) | 70(30.0) | 52(28.4) | 18(36.0) | 0.300 |
| Blood pressure, mmHg | ||||
| SBP, median (IQR)a | 135(127–146) | 134(127–140) | 140(128–150) | 0.032 |
| DBP, median (IQR)a | 72(66–80) | 72(67–80) | 72(66–79) | 0.546 |
| PP, median (IQR)a | 61(53–71) | 60(51–70) | 66(55–82) | 0.041 |
Significance difference P < 0.05 was shown in bold. All data were analyzed by the chi-square test unless marked
Abbreviations: IQR Interquartile range, SBP Systolic blood pressure, DBP Diastolic blood pressure, PP Pulse pressure
athe Mann–Whitney U-test
Both SBP and PP demonstrated significant inverse associations with the IC composite score. Specifically, these parameters were negatively associated with the cognition and locomotion IC domains (all P < 0.05). In contrast, DBP showed a significant positive association with the locomotion domain (P < 0.05) (Table 3).
Table 3.
Association between hypertension correlated characteristics and IC domains
| MMSE | Four-meter walk | IC composite score | |
|---|---|---|---|
| SBP(r) | −0.177 | −0.156 | −0.143 |
| DBP(r) | −0.031 | 0.190 | 0.106 |
| PP(r) | −0.151 | −0.246 | −0.191 |
Significance difference P < 0.05 was shown in bold. Spearman rank correlation analysis indicates statistically significant difference
Abbreviations: SBP Systolic blood pressure, DBP, Diastolic blood pressure, PP Pulse pressure, IC Intrinsic capacity, MMSE Mini-mental state examination
The logistic regression analysis showed that cognitive decline and locomotion impairment were independently associated with significantly increased risk of functional disability (OR = 3.08, 95% CI: 1.41–6.69, P = 0.005; OR = 3.35, 95% CI: 1.30–8.63, P = 0.012) in older hypertensive inpatients after 1-year follow-up when adjusted the possible confounders. Furthermore, a higher IC composite score at admission was associated with a lower one-year risk of functional disability (OR = 0.57, 95% CI: 0.40–0.80, P = 0.001) (Table 4).
Table 4.
Associations of influence factors and functional disability over one-year follow-up using multivariate regression model
| OR (95%CI) | P value | R2 | |
|---|---|---|---|
| IC domains | |||
| Cognitive decline | 3.08(1.41,6.69) | 0.005 | 0.363 |
| Locomotion impairment | 3.35(1.30,8.63) | 0.012 | 0.357 |
| Malnutrition risk | 1.94(0.89,4.26) | 0.098 | 0.335 |
| Depression | 2.29(0.81,6.51) | 0.119 | 0.333 |
| Hearing impairment | 0.69(0.32,1.49) | 0.344 | 0.325 |
| Vision impairment | 1.60(0.73,3.51) | 0.243 | 0.328 |
| IC composite score | 0.57(0.40,0.80) | 0.001 | 0.377 |
After adjusting age, sex, married, polypharmacy, comorbidities, SBP, DBP, uncontrolled hypertension, hypertension stage and hypertension duration. Significance difference P < 0.05 was shown in bold
Abbreviations: IC Intrinsic capacity, OR Odds ratio, CI Confidence interval, SBP Systolic blood pressure, DBP Diastolic blood pressure
Discussion
This study demonstrates that both SBP and PP negatively correlate with IC in elderly hypertensive inpatients, particularly impairing cognition and locomotion domains. Crucially, a higher IC composite score at admission predicted a reduced risk of functional disability within one year.
Locomotion impairment emerged as a predominant issue in this population, affecting 55.8% of elderly hypertensive inpatients. This prevalence aligns with findings by Zhu et al. in hospitalized older adults [40], but exceeds rates in community-based cohorts [41, 42], underscoring the heightened vulnerability within the hospitalized setting. Hospitalization is a major trigger for long-term disability in older adults [43–45], with new-onset disability incidence ranging widely from 5 to 50% and being strongly associated with increased adverse outcomes [46–50]. Locomotion capacity, particularly gait speed, serves as a key indicator of systemic vascular health and physical resilience in older adults [51]. In our cohort, compared with older patients exhibiting a normal gait, those with a slow gait speed had a 2.35-fold increased risk of functional disability. This is consistent with its established role as a quantifiable predictor of long-term functional disability, loss of independence, and survival [52–54]. Notably, hypertension-induced cerebral microangiopathy (e.g., white matter lesions, WMLs) may concurrently compromise locomotion and cognition, WMLs in specific brain regions directly correlating with slow gait speed, thereby synergistically amplifying functional disability risk [55–57].
Functional disability is critically linked to hypertension-mediated vascular pathophysiology. Elevated blood pressure accelerates arterial stiffness, impairing cerebral perfusion and disrupting motor control circuits [58–62], which significantly contributes to the association between slow gait speed and ADL limitations [63, 64]. Individuals with high blood pressure exhibit slower baseline gait speed and a faster rate of decline compared to normotensive peers [25, 65]. The LIFE-Pilot trial found that higher PP, an indicator of vascular health, correlates with slower gait speed [66]. Moreover, higher brachial artery pulse pressure, a marker of aortic stiffness, was linked to slower gait speed across a broad age range (5—70 years) [67]. Conversely, among adults aged ≥ 85 years, lower SBP is associated with increased ADL limitations and greater risk of function disability deterioration [68]. This relationship underscores that optimal blood pressure targets must be individualized to preserve locomotion capacity, particularly avoiding both sustained hypertension and excessive blood pressure reduction in the elderly.
Hypertension accelerates neurodegeneration via cerebral small vessel disease and exacerbates cognitive decline through cerebrovascular pathology, directly contributing to ADL limitations and significantly impairing self-care abilities and quality of life in older adults [69]. A population-based study of elderly Mexican Americans showed that individuals with MMSE scores below 21 had a 58% higher risk of developing ADL limitations over seven years compared to those with normal cognitive function [70]. Notably, our prior research in hospitalized older adults corroborated this relationship, showing that cognitive decline at admission predicted future ADL and IADL dependence [18]. This study similarly confirms that baseline cognitive decline predicts one-year incident ADL dependence in hypertensive older adults.
As a core indicator of functional ability, IC serves is a validated predictor of future disability [17, 71]. Analysis of the UK Biobank database indicated that older adults with cardiovascular diseases, including hypertension, are more prone to IC deficits, which are associated with increased CVD incidence and poorer prognosis [29]. Dai et al. [72] and the CHARLS study [73] reveal a cumulative effect of hypertension and ADL limitations, significantly elevating the risk of cardiovascular events and adverse outcomes. Additionally, a mean home SBP ≥ 135 mmHg is significantly associated with functional dependence in the elderly [74]. These findings underscore the clinical imperative for early identification and proactive management of IC decline in hypertensive older adults. Frameworks such as the WHO Integrated Care for Older People (ICOPE), designed for continuous of IC domains monitoring, could provide a structured approach. To achieve this, we strongly suggest integrating the WHO ICOPE framework into hypertension management protocols. Continuous monitoring of IC core domains (especially locomotion and cognition) identifies essential targets for multimodal interventions (including precise blood pressure control, exercise training, cognitive stimulation, and nutritional support) to effectively interrupt the progression from hypertension to functional disability.
This study has several strengths. First, we simultaneously evaluated cognition, locomotion, vitality, psychology, and sensory domains, providing a comprehensive assessment of hypertensive impact on IC subcomponents and their contribution to disability. Second, our study specifically identifies the clinical association between declined IC and one-year functional disability risk specifically in hospitalized older hypertensive adults, underscoring the critical need to monitor gait speed and cognitive function for disability prevention.
Several limitations warrant acknowledgment. First, the retrospective cohort design, while providing longitudinal observation, limits causal inference. Specifically, the inability to precisely determine the onset of IC decline, track trajectories of individual IC domains, or confirm the exact timing of functional disability onset hinders our ability to delineate the complete causal pathway between the exposures (IC decline) and the outcome (functional disability). Future prospective studies with longitudinal assessments are needed to confirm causation and establish temporal sequences. Second, although SBP and PP negatively correlated with the IC composite score, further validation through methods such as simultaneous ambulatory blood pressure monitoring and objective physical performance assessment is required. Third, the hospital-based sampling limits generalizability to community-dwelling elders or non-hypertensive populations. Finally, dichotomization of IC domains may obscure subtle impairments and reduce measurement sensitivity.
Conclusions
Lower IC composite scores at admission predict an increased risk of functional disability 1-year post-discharge in elderly hypertensive inpatients. Higher SBP and PP negatively related to IC composite score, particularly impairing cognition and locomotion. Cognitive decline and locomotion impairment independently increase disability risk. Controlling elevated SBP and PP is crucial to mitigate cognitive and locomotion decline. Early identification and proactive management of declined IC are critical for multimodal intervention and disability prevention. Future research should validate these findings in larger prospective cohorts with subgroup analyses to refine risk stratification, elucidate underlying mechanisms (e.g., endothelial dysfunction) linking hypertension to IC decline, and test IC-based interventions, combining with targeted hypertension control to preserve functional independence and quality of life in elderly hypertensive populations.
Acknowledgements
We sincerely thank the staff from the Geriatric Department of Zhejiang Hospital for their positive involvement in this study.
Authors’ contributions
SS, WY and ZX contributed to conceptualization and methodology. ZX and GH analyzed the data and wrote the original draft. All the authors contributed to interpreting the results, and revising and approving the final manuscript.
Funding
This work is supported by the"Leading Goose + X"Science and Technology Program of Zhejiang Province of China (2025C02104), the Zhejiang Medical Science and Technology Project (No.2025KY536), and the “3060” personnel training project from Zhejiang Hospital (No.20226027).
Data availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
This study was approved by the Medical Ethics Committee of Zhejiang Hospital (2013–25).Our research complies with the guidelines for human studies and was conducted ethically in accordance with the World Medical Association Declaration of Helsinki.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Xingkun Zeng and Huilan Guan contributed equally to this work.
Contributor Information
Yanyan Wang, Email: wangyanyan0303@163.com.
Shanshan Shen, Email: shenshan305@163.com.
References
- 1.Center For Cardiovascular Diseases The Writing Committee Of The Report On Cardiovascular H, Diseases In China N. Report on Cardiovascular Health and Diseases in China 2023: An Updated Summary. Biomed Environ Sci. 2024; 37(9):949–92. [DOI] [PubMed]
- 2.Li L, Duan L, Xu Y, et al. Hypertension in frail older adults: current perspectives. PeerJ. 2024;12: e17760. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;394(10204):1145–58. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Diseases GBD, Injuries C. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–22. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Wilson LM, Herzig SJ, Steinman MA, et al. Management of inpatient elevated blood pressures: a systematic review of clinical practice guidelines. Ann Intern Med. 2024;177(4):497–506. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Sierra C. Hypertension in older adults. Hipertens Riesgo Vasc. 2017;34(Suppl 2):26–9. [DOI] [PubMed] [Google Scholar]
- 7.Oliveros E, Patel H, Kyung S, et al. Hypertension in older adults: assessment, management, and challenges. Clin Cardiol. 2020;43(2):99–107. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Spitz JA, Yang E, Blumenthal RS, et al. Public health messaging to older adults about hypertension. Clin Geriatr Med. 2024;40(4):669–83. [DOI] [PubMed] [Google Scholar]
- 9.Guasti L, Ambrosetti M, Ferrari M, et al. Management of hypertension in the elderly and frail patient. Drugs Aging. 2022;39(10):763–72. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Ungar A, Rivasi G, Coscarelli A, et al. Hypertension in the elderly: why one size does not fit all. Minerva Med. 2022;113(4):616–25. [DOI] [PubMed] [Google Scholar]
- 11.Bahat G, Ribeiro H, Sheppard JP, et al. Twelve hot questions in the management of hypertension in patients aged 80+ years and their answers with the help of the 2023 European Society of Hypertension Guidelines. J Hypertens. 2024;42(11):1837–47. [DOI] [PubMed] [Google Scholar]
- 12.Hu K, Zhou G, Jiang M, et al. Hypertension treatment in frail older adults: a systematic review and appraisal of guidelines. Drugs Aging. 2023;40(10):881–93. [DOI] [PubMed] [Google Scholar]
- 13.Roulet C, Rozsnyai Z, Jungo KT, et al. Managing hypertension in frail oldest-old-the role of guideline use by general practitioners from 29 countries. PLoS ONE. 2020;15(7): e0236064. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Beard JR, Officer A, de Carvalho IA, et al. The world report on ageing and health: a policy framework for healthy ageing. Lancet. 2016;387(10033):2145–54. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Liu S, Yu X, Wang X, et al. Intrinsic capacity predicts adverse outcomes using integrated care for older people screening tool in a senior community in Beijing. Arch Gerontol Geriatr. 2021;94:104358. [DOI] [PubMed] [Google Scholar]
- 16.Gonzalez-Bautista E, de SoutoBarreto P, Andrieu S, et al. Screening for intrinsic capacity impairments as markers of increased risk of frailty and disability in the context of integrated care for older people: secondary analysis of MAPT. Maturitas. 2021;150:1–6. [DOI] [PubMed] [Google Scholar]
- 17.Jia S, Zhao W, Ge M, et al. Associations between transitions of intrinsic capacity and frailty status, and 3-year disability. BMC Geriatr. 2023;23(1):96. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Zeng X, Shen S, Xu L, et al. The impact of intrinsic capacity on adverse outcomes in older hospitalized patients: a one-year follow-up study. Gerontology. 2021;67(3):267–75. [DOI] [PubMed] [Google Scholar]
- 19.Nagae M, Umegaki H, Komiya H, et al. Intrinsic capacity in acutely hospitalized older adults. Exp Gerontol. 2023;179: 112247. [DOI] [PubMed] [Google Scholar]
- 20.Campbell CL, Cadar D, McMunn A, et al. Operationalization of intrinsic capacity in older people and its association with subsequent disability, hospital admission and mortality: results from the English Longitudinal Study of Ageing. J Gerontol A Biol Sci Med Sci. 2023;78(4):698–703. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Yu R, Lai ETC, Leung G, et al. Intrinsic capacity and 10-year mortality: findings from a cohort of older people. Exp Gerontol. 2022;167:111926. [DOI] [PubMed] [Google Scholar]
- 22.Zhang B, Hu M, Sun Y, et al. Associations between the prevalence, treatment, control of hypertension and cognitive trajectories among Chinese middle-aged and older adults. Am J Geriatr Psychiatry. 2022;30(10):1123–34. [DOI] [PubMed] [Google Scholar]
- 23.Qiu W, Cai A, Li L, et al. Association of depression trajectories and subsequent hypertension and cardiovascular disease: findings from the CHARLS cohort. J Hypertens. 2024;42(3):432–40. [DOI] [PubMed] [Google Scholar]
- 24.Odden MC, Peralta CA, Haan MN, et al. Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med. 2012;172(15):1162–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Rosano C, Longstreth WT Jr., Boudreau R, et al. High blood pressure accelerates gait slowing in well-functioning older adults over 18-years of follow-up. J Am Geriatr Soc. 2011;59(3):390–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Friedland DR, Cederberg C, Tarima S. Audiometric pattern as a predictor of cardiovascular status: development of a model for assessment of risk. Laryngoscope. 2009;119(3):473–86. [DOI] [PubMed] [Google Scholar]
- 27.Huo X, Wu M, Gao D, et al. Geriatric nutrition risk index in the prediction of all-cause and cardiovascular mortality in elderly hypertensive population: NHANES 1999–2016. Front Cardiovasc Med. 2023;10:1203130. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Cao X, Yi X, Chen H, et al. Prevalence of intrinsic capacity decline among community-dwelling older adults: a systematic review and meta-analysis. Aging Clin Exp Res. 2024;36(1):157. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Ramirez-Velez R, Iriarte-Fernandez M, Santafe G, et al. Association of intrinsic capacity with incidence and mortality of cardiovascular disease: prospective study in UK Biobank. J Cachexia Sarcopenia Muscle. 2023;14(5):2054–63. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Md State Med J. 1965;14:61–5. [PubMed] [Google Scholar]
- 31.Salive ME. Multimorbidity in older adults. Epidemiol Rev. 2013;35:75–83. [DOI] [PubMed] [Google Scholar]
- 32.Masnoon N, Shakib S, Kalisch-Ellett L, et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1): 230. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Viktil KK, Blix HS, Moger TA, et al. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. Br J Clin Pharmacol. 2007;63(2):187–95. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Nuotio J, Suvila K, Cheng S, et al. Longitudinal blood pressure patterns and cardiovascular disease risk. Ann Med. 2020;52(3–4):43–54. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Joint Committee for Guideline R. 2018 Chinese Guidelines for Prevention and Treatment of Hypertension-A report of the Revision Committee of Chinese Guidelines for Prevention and Treatment of Hypertension. J Geriatr Cardiol. 2019; 16(3):182–241. [DOI] [PMC free article] [PubMed]
- 36.Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189–98. [DOI] [PubMed]
- 37.Chen LK, Woo J, Assantachai P, et al. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. 2020; 21(3):300–07 e2. [DOI] [PubMed]
- 38.Kaiser MJ, Bauer JM, Ramsch C, et al. Validation of the mini nutritional assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging. 2009;13(9):782–8. [DOI] [PubMed] [Google Scholar]
- 39.Dennis M, Kadri A, Coffey J. Depression in older people in the general hospital: a systematic review of screening instruments. Age Ageing. 2012;41(2):148–54. [DOI] [PubMed] [Google Scholar]
- 40.Zhu L, Shen X, Shi X, et al. Factors associated with intrinsic capacity impairment in hospitalized older adults: a latent class analysis. BMC Geriatr. 2024;24(1): 494. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 41.Meng LC, Hsiao FY, Huang ST, et al. Intrinsic capacity impairment patterns and their associations with unfavorable medication utilization: a nationwide population-based study of 37,993 community-dwelling older adults. J Nutr Health Aging. 2022;26(10):918–25. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42.Ma L, Chhetri JK, Zhang L, et al. Cross-sectional study examining the status of intrinsic capacity decline in community-dwelling older adults in China: prevalence, associated factors and implications for clinical care. BMJ Open. 2021;11(1): e043062. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 43.Loyd C, Beasley TM, Miltner RS, et al. Trajectories of community mobility recovery after hospitalization in older adults. J Am Geriatr Soc. 2018;66(7):1399–403. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 44.Gill TM, Allore HG, Gahbauer EA, et al. Change in disability after hospitalization or restricted activity in older persons. JAMA. 2010;304(17):1919–28. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 45.Anpalahan M, Gibson SJ. Geriatric syndromes as predictors of adverse outcomes of hospitalization. Intern Med J. 2008;38(1):16–23. [DOI] [PubMed] [Google Scholar]
- 46.Portegijs E, Buurman BM, Essink-Bot ML, et al. Failure to regain function at 3 months after acute hospital admission predicts institutionalization within 12 months in older patients. J Am Med Dir Assoc. 2012; 13(6):569 e1–7. [DOI] [PubMed]
- 47.Hoogerduijn JG, Buurman BM, Korevaar JC, et al. The prediction of functional decline in older hospitalised patients. Age Ageing. 2012;41(3):381–7. [DOI] [PubMed] [Google Scholar]
- 48.Boyd CM, Landefeld CS, Counsell SR, et al. Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc. 2008;56(12):2171–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 49.Drame M, Jovenin N, Novella JL, et al. Predicting early mortality among elderly patients hospitalised in medical wards via emergency department: the SAFES cohort study. J Nutr Health Aging. 2008;12(8):599–604. [DOI] [PubMed] [Google Scholar]
- 50.Walter LC, Brand RJ, Counsell SR, et al. Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA. 2001;285(23):2987–94. [DOI] [PubMed] [Google Scholar]
- 51.Mehmet H, Robinson SR, Yang AWH. Assessment of gait speed in older adults. J Geriatr Phys Ther. 2020;43(1):42–52. [DOI] [PubMed] [Google Scholar]
- 52.Middleton A, Fritz SL, Lusardi M. Walking speed: the functional vital sign. J Aging Phys Act. 2015;23(2):314–22. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 53.Vermeulen J, Neyens JC, van Rossum E, et al. Predicting ADL disability in community-dwelling elderly people using physical frailty indicators: a systematic review. BMC Geriatr. 2011;11:33. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 54.Studenski S, Perera S, Patel K, et al. Gait speed and survival in older adults. JAMA. 2011;305(1):50–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 55.Perrotta M, Lembo G, Carnevale D. Hypertension and dementia: epidemiological and experimental evidence revealing a detrimental relationship. Int J Mol Sci. 2016;17(3): 347. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 56.Bolandzadeh N, Liu-Ambrose T, Aizenstein H, et al. Pathways linking regional hyperintensities in the brain and slower gait. Neuroimage. 2014;99:7–13. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 57.Soros P, Whitehead S, Spence JD, et al. Antihypertensive treatment can prevent stroke and cognitive decline. Nat Rev Neurol. 2013;9(3):174–8. [DOI] [PubMed] [Google Scholar]
- 58.Liu H, Meng T, Qie R. Causal associations with arterial stiffness and sarcopenia: a Mendelian randomization analysis. Rejuvenation Res. 2025;28(2):83–91. [DOI] [PubMed] [Google Scholar]
- 59.Reeve EH, Barnes JN, Moir ME, et al. Impact of arterial stiffness on cerebrovascular function: a review of evidence from humans and preclincal models. Am J Physiol Heart Circ Physiol. 2024;326(3):H689–704. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 60.Takahashi T, Nakano H, Shiina K, et al. Central systolic blood pressure as a risk factor for accelerated progression of arterial stiffness. J Atheroscler Thromb. 2024;31(2):180–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 61.Lim SL, Liu X, Gao Q, et al. Subclinical vasculopathy and skeletal muscle metrics in the Singapore longitudinal ageing study. Aging (Albany NY). 2021;13(11):14768–84. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 62.AlGhatrif M, Lakatta EG. The conundrum of arterial stiffness, elevated blood pressure, and aging. Curr Hypertens Rep. 2015;17(2):12. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 63.Weidung B, Bostrom G, Toots A, et al. Blood pressure, gait speed, and mortality in very old individuals: a population-based cohort study. J Am Med Dir Assoc. 2015;16(3):208–14. [DOI] [PubMed] [Google Scholar]
- 64.Canavan M, Smyth A, Bosch J, et al. Does lowering blood pressure with antihypertensive therapy preserve independence in activities of daily living? A systematic review. Am J Hypertens. 2015;28(2):273–9. [DOI] [PubMed] [Google Scholar]
- 65.Dumurgier J, Elbaz A, Dufouil C, et al. Hypertension and lower walking speed in the elderly: the Three-City study. J Hypertens. 2010;28(7):1506–14. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 66.Heffernan KS, Manini TM, Hsu FC, et al. Relation of pulse pressure to long-distance gait speed in community-dwelling older adults: findings from the LIFE-P study. PLoS ONE. 2012;7(11): e49544. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 67.Sahni S, Dufour AB, Wang N, et al. Association of vascular health measures and physical function: a prospective analysis in the Framingham Heart Study. J Gerontol A Biol Sci Med Sci. 2023;78(7):1189–97. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 68.Sabayan B, Oleksik AM, Maier AB, et al. High blood pressure and resilience to physical and cognitive decline in the oldest old: the Leiden 85-plus study. J Am Geriatr Soc. 2012;60(11):2014–9. [DOI] [PubMed] [Google Scholar]
- 69.Ryan A, Wallace E, O’Hara P, et al. Multimorbidity and functional decline in community-dwelling adults: a systematic review. Health Qual Life Outcomes. 2015;13:168. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 70.Raji MA, Al Snih S, Ray LA, et al. Cognitive status and incident disability in older Mexican Americans: findings from the Hispanic established population for the epidemiological study of the elderly. Ethn Dis. 2004;14(1):26–31. [PubMed] [Google Scholar]
- 71.Beard JR, Jotheeswaran AT, Cesari M, et al. The structure and predictive value of intrinsic capacity in a longitudinal study of ageing. BMJ Open. 2019;9(11): e026119. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 72.Dai LY, Ma JX, Tao T. Impacts of chronic diseases on limited basic activities of daily living in middle-aged and elderly people in China. Chin J Public Health. 2018;34(10):1365–8. [Google Scholar]
- 73.Li Y, Jiang M, Ren X, et al. Hypertension combined with limitations in activities of daily living and the risk for cardiovascular disease. BMC Geriatr. 2024;24(1): 225. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 74.Nishinaga M, Takata J, Okumiya K, et al. High morning home blood pressure is associated with a loss of functional independence in the community-dwelling elderly aged 75 years or older. Hypertens Res. 2005;28(8):657–63. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.