Managing hypertension, diabetes, and dyslipidemia in frail older adults

As the population ages, the prevalence of chronic conditions, such as hypertension, type 2 diabetes, and dyslipidemia, is rapidly increasing, particularly among frail older adults. These conditions share common pathophysiological mechanisms and substantially contribute to the development of atherosclerotic cardiovascular disease. Effective management is essential for reducing cardiovascular risk; however, older adults present unique challenges, including multimorbidity, polypharmacy, cognitive decline, and functional impairment. Frailty further complicates clinical decision-making and necessitates individualized treatment strategies. This review examines current evidence and clinical guidelines for managing hypertension, diabetes, and dyslipidemia in older adults, with a focus on frailty status. It highlights the importance of assessing functional capacity and life expectancy and prioritizing treatments with favorable risk–benefit profiles. Specific recommendations are discussed according to frailty status, including when to initiate or deintensify therapy. Ultimately, a person-centered, geriatric-informed approach is critical to optimize outcomes and preserve quality of life in this vulnerable population.