Dear Editor,
We thank Dr Tomoyuki Kawada for the valuable and thoughtful comments regarding our published work.1 We are pleased to provide the specific answers below.
We are fully aware that metabolic disorders are associated with frailty, and in our previous study, we had observed that diabetic patients had a higher prevalence of frailty than those without the condition.2 These findings are in accordance with the study by Castrejón‐Pérez.3 The main purpose of our study (as stated in the title of the paper) was to investigate the prevalence of frailty and its ability to predict mortality in hypertensive Chinese older adults. Therefore, although we appreciate Dr Kawada's point on the effect of metabolic disorders, we have not considered including metabolic disorders or diabetic complications in this study.
Dr Kawada has raised concerns regarding the use of antihypertensive medication and the risk of serious fall injuries in hypertensive older adults. Our data showed that although frail older adults had both higher systolic and diastolic blood pressure compared to non‐frail participants (P < 0.05), blood pressure was not an independent associated factor for frailty on logistic regression. As we have previously discussed, blood pressure is lower in frail patients, and they might easily be over‐treated according to the current European guidelines.4 We emphasize that in this study, we only aimed to investigate the prevalence of frailty in hypertensive older Chinese adults, and not to explore all the relevant factors associated with frailty. Caution should be taken when interpreting such data because of the disparities in the methods and populations of different studies. In our future study, we will investigate whether antihypertensive medication is associated with frailty and mortality in this population.
With regard to cognitive frailty, we demonstrated its prevalence to be 3.3% in Chinese older adults and explored its associated factors.5 In older adults, physical frailty and cognitive impairment are both associated with worse outcomes. In this study, we found the psychological status (cognitive impairment and depression) in frail older adults to be worse than that of non‐frail participants. However, logistic regression showed that cognitive impairment was not an independent risk factor for frailty. This highlights the importance of physical intervention in hypertensive older adults, as we have stated in the paper.
Finally, we do believe that an appropriate screening tool for frailty should be used to avoid adverse outcomes in Chinese older adults. In fact, we have developed and validated a frailty screening tool (FSQ) to ease the screening for frailty in clinical and community settings.6 Furthermore, we have proposed a two‐step pathway for frailty measurement (the first step is to screen for frailty using a self‐reported tool such as FSQ and the second step is to assess frailty using performed measurement, or comprehensive geriatric assessment).7
In conclusion, frailty is a prevalent and growing public health burden and is predictive of subsequent mortality in older adults. We agree with our colleague that the interaction between metabolic disorders, balancing the risks of antihypertensive medication, and the coexistence of cognitive impairment are important considerations in the management of frail hypertensive older adults in clinical practice. Further studies on blood pressure control, trajectory of frailty, and prognosis are necessary. In particular, prospective clinical trials on antihypertensive therapy in frail Chinese older adults are urgently required.
CONFLICT OF INTEREST
The authors report no conflicts of interest.
REFERENCES
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