Associations between hypertension and frailty among middle-aged and older adults: evidence from the longitudinal ageing study in India

BACKGROUND: The global demographic shift has highlighted the co-occurrence of hypertension (HTN) and physical frailty, both of which severely impact the health outcomes and quality of life of middle-aged and older adults. This relationship remains underexplored in India's rapidly ageing population. METHODS: We conducted a cross-sectional analysis using data from the Longitudinal Ageing Study in India (Wave 1), comprising a nationally representative sample of 66,606 participants. Physical frailty was assessed using a modified Fried phenotype. Multivariable logistic regression and the Karlson-Holm-Breen method were utilised to evaluate associations and quantify the mediating effect of additional comorbidities. RESULTS: The weighted prevalence of physical frailty among participants with HTN was 19.26% (95% CI: 18.43, 20.11). Multivariable analysis revealed that advanced age, lack of education, non-working status, underweight BMI, and presence of additional comorbidities were significantly associated with higher odds of frailty in HTN patients. Mediation analysis showed that additional comorbidities accounted for 21.31% of the total effect of HTN on frailty for all HTN cases, and 38.36% for previously diagnosed cases. CONCLUSION: Treating HTN in isolation might be insufficient for addressing functional decline. Healthcare policies and clinical practices must adopt comprehensive geriatric assessments that target patients' entire comorbid profiles, while prioritising interventions that address the modifiable risk factors.