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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Eduvest - Journal of Universal Studies
Rose Dinda Martini
Faculty Of Medicine, Andalas University
Aerospace Engineering Biochemistry, Genetics & Molecular Biology Computer Science & IT Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Social Sciences

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Efficacy and Safety of Intensive Blood Pressure Lowering on Cardiovascular Outcomes and Orthostatic Hypotension in Frail vs. Non-Frail Elderly Patients: A Systematic Review and Meta-Analysis Dian Arfan As Bahri; Rose Dinda Martini; Roza Mulyana; Fandi Triansyah
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i6.1598

Abstract

Background: The management of hypertension in the older adult population presents a complex clinical challenge, particularly regarding the balance between cardiovascular risk reduction and the provocation of adverse events such as orthostatic hypotension. Frailty status complicates this dynamic, creating uncertainty regarding the optimal blood pressure target. Methods: A systematic review and meta-analysis investigated the efficacy and safety of intensive versus standard blood pressure lowering in frail compared to non-frail older adults. Databases were systematically searched for randomized controlled trials and their secondary analyses reporting cardiovascular outcomes and orthostatic hypotension stratified by frailty. Data were extracted and synthesized using a random-effects model, calculating pooled risk ratios and standardized mean differences to assess primary cardiovascular events and safety outcomes. Results: Ten primary studies met the inclusion criteria. Intensive blood pressure lowering significantly reduced the incidence of major cardiovascular events in both non-frail and frail cohorts. Surprisingly, intensive treatment did not increase the risk of orthostatic hypotension in frail patients and was associated with a protective effect against orthostatic hypotension in specific subsets. The risk of bias was generally low across the included trials. Conclusion: Intensive blood pressure control provides substantial cardiovascular benefits for older adults, irrespective of baseline frailty status. Furthermore, the aggressive lowering of blood pressure does not exacerbate the risk of orthostatic hypotension, challenging previous clinical hesitations. These findings support the cautious but deliberate implementation of intensive targets in the geriatric population, monitored closely by comprehensive geriatric assessments.
The Correlation Between Sarcopenia And Transthyretin Levels Among Community-Dwelling Older Adults In Padang, West Sumatra R. Ifan Arief Fahrurozi; Rose Dinda Martini; Roza Mulyana; Fandi Triansyah
Eduvest - Journal of Universal Studies Vol. 4 No. 11 (2024): Journal Eduvest - Journal of Universal Studies
Publisher : Green Publisher Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59188/eduvest.v4i11.49959

Abstract

The objective of this study was to evaluate the correlation between sarcopenia and transthyretin levels among community-dwelling older adults in Padang. This study employed a cross-sectional design and included 45 community-dwelling individuals aged 60 years and above who visited Andalas Primary Health Care in Padang, West Sumatra, Indonesia. Characteristics of sociodemographic and lifestyle habits were collected using a general questionnaire. Sarcopenia was defined in accordance with the criteria set forth by the Asian Working Group for Sarcopenia (AWGS) criteria encompass three components: low muscle mass, as determined by an index of appendicular skeletal mass/height2 less than 7,0 kg/m2 for males and less than 5,7 kg/m2 for females; low physical performance, as indicated by a gait speed less than 1,0 m/s; low muscle strength, defined as handgrip strength less than 26 kg for males and less than 18 kg for females. Accordingly, sarcopenia was defined as the presence of low muscle mass in conjunction with low physical performance and/or low muscle strength. Transthyretin levels were considered as independent variables in order to evaluate the potential correlation between transthyretin and sarcopenia status using bivariate analysis. The overall prevalence of sarcopenia was 51.1%, with four cases (40%) observed in males and 19 cases (54.3%) in females classified as having sarcopenia. The prevalence of sarcopenia was significantly lower among participants with normal nutritional status. A comparison of the participants with and without sarcopenia revealed that the former exhibited higher levels of transthyretin (p = 0,000).
Efficacy and Safety of Intensive Blood Pressure Lowering on Cardiovascular Outcomes and Orthostatic Hypotension in Frail vs. Non-Frail Elderly Patients: A Systematic Review and Meta-Analysis Dian Arfan As Bahri; Rose Dinda Martini; Roza Mulyana; Fandi Triansyah
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i6.1598

Abstract

Background: The management of hypertension in the older adult population presents a complex clinical challenge, particularly regarding the balance between cardiovascular risk reduction and the provocation of adverse events such as orthostatic hypotension. Frailty status complicates this dynamic, creating uncertainty regarding the optimal blood pressure target. Methods: A systematic review and meta-analysis investigated the efficacy and safety of intensive versus standard blood pressure lowering in frail compared to non-frail older adults. Databases were systematically searched for randomized controlled trials and their secondary analyses reporting cardiovascular outcomes and orthostatic hypotension stratified by frailty. Data were extracted and synthesized using a random-effects model, calculating pooled risk ratios and standardized mean differences to assess primary cardiovascular events and safety outcomes. Results: Ten primary studies met the inclusion criteria. Intensive blood pressure lowering significantly reduced the incidence of major cardiovascular events in both non-frail and frail cohorts. Surprisingly, intensive treatment did not increase the risk of orthostatic hypotension in frail patients and was associated with a protective effect against orthostatic hypotension in specific subsets. The risk of bias was generally low across the included trials. Conclusion: Intensive blood pressure control provides substantial cardiovascular benefits for older adults, irrespective of baseline frailty status. Furthermore, the aggressive lowering of blood pressure does not exacerbate the risk of orthostatic hypotension, challenging previous clinical hesitations. These findings support the cautious but deliberate implementation of intensive targets in the geriatric population, monitored closely by comprehensive geriatric assessments.
Co-Authors Dian Arfan As Bahri Fandi Triansyah Fandi Triansyah R. Ifan Arief Fahrurozi Roza Mulyana Roza Mulyana