Influence of frailty syndrome on compliance with therapeutic recommendations by elderly patients with hypertension
Authors: Jankowska-Polanska B , Jez K , Swiatoniowska-Lonc N , Polanski J 
Published: May 2021

Funding Acknowledgements

Type of funding sources: None.

Background. Hypertension (HTN) is a common medical problem and is one of the most common causes of morbidity and mortality in developed countries. Due to the low level of compliance with therapeutic recommendations, correct and effective treatment of HTN in elderly patients is particularly difficult. The main reasons for non-compliance include: old age, financial restrictions, side effects of the medicines taken, limited physical activity, cognitive abnormalities and frailty syndrome. Literature shows an increased risk of frailty in elderly hypertensive patients, but there are few reports of the impact of frailty syndrome on compliance with therapeutic recommendations.

The aim of the study is to assess the influence of frailty syndrome on the level of compliance with therapeutic recommendations by elderly patients with arterial hypertension.

Material and methods. 130 patients (56 men) aged 73.6 ± 7.3 years hospitalized in the cardiology department due to uneven blood pressure. Standardized tools were used in the study: Tilburg Frailty Indicator (TFI) to assess frailty syndrome and Hill Bone High Blood Pressure Compliance Scale to assess the level of compliance with therapeutic recommendations. Patients were divided depending on the result of the Tillburg questionnaire; the first group - without frailty syndrome (&lt;4 N = 19; 14.62%), the second group - with frailty syndrome (≥5 N = 111; 85.38%).

Results. Patients with frailty syndrome had more frequent coexisting diseases (66.67% vs. 42.11%; p = 0.005) and had longer HTN (13.8 ± 9.6 vs. 8.7 ± 5.1; p = 0.027) compared to patients without frailty syndrome. No differences in other sociodemographic variables were observed. Correlation analysis showed that the higher intensity of physical components of frailty, the lower the level of compliance with pharmacological recommendations (r = 0.227; p = 0.01), and the higher intensity of social components of frailty, the lower the overall level of compliance (r = 0.212; p = 0.016), the level of compliance with pharmacological recommendations (r = 0.186; p = 0.035) and the level of compliance with recommendations for control visits (r = 0.205; p = 0.019). The multifactorial linear regression model showed that an independent determinant of compliance with therapeutic recommendations for sodium intake reduction are concomitant diseases (β=0.883; p = 0.032) and for pharmacotherapy the physical components of frailty syndrome (β=0.763; p = 0.02). An independent determinant of visiting a doctor is HTN education (β=-0.833; p = 0.024).

Conclusions. Frailty syndrome is often present in elderly people with HTN, especially in people who have been suffering from HTN for a longer period of time and with multi-disease. Physical components of frailty syndrome are an independent predictor of compliance with pharmacological recommendations. The values of social components of frailty syndrome have a negative impact on the control visits to the doctor and on the compliance with pharmacological recommendations.