The impact of blood pressure lowering agents on the risk of worsening frailty among patients with diabetes mellitus: a cohort study

Patients with diabetes mellitus (DM) are at risk of developing frailty, but studies rarely addressed risk factors for frailty worsening. We investigated whether blood pressure (BP)-lowering agents influenced such risk in these patients. Adults with type 2 DM were identified from National Taiwan University Hospital, with the primary outcome, the worsening of frailty by ≧1 score increase of FRAIL scale determined. We used the Cox proportional hazards analysis to derive the risk of worsening frailty associated with BP-lowering agents. Among 41,440 patients with DM, 27.4% developed worsening frailty after 4.09 years of follow-up. Cox regression revealed that diuretics (hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.06-1.18) and α-blocker (HR 1.14, 95% CI 1.06-1.23) users had a significantly higher risk of worsening frailty than non-users, whereas the risk was lower among β-blocker users (HR 0.93, 95% CI 0.88-0.98). It would be therefore prudent to weigh the advantages and disadvantages of using specific BP-lowering agent classes.