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. 2023 Feb;80(2):305-313.
doi: 10.1161/HYPERTENSIONAHA.122.20141. Epub 2022 Oct 18.

Systolic Blood Pressure Time in Target Range and Major Adverse Kidney and Cardiovascular Events

Leo F Buckley  1 , William L Baker  2 , Benjamin W Van Tassell  3 , Jordana B Cohen  4 , Omar Alkhezi  1   5 , Adam P Bress  6 , Dave L Dixon  3
Affiliations

Systolic Blood Pressure Time in Target Range and Major Adverse Kidney and Cardiovascular Events

Leo F Buckley et al. Hypertension. 2023 Feb.

Abstract

Background: Whether time-in-target range (TTR) for systolic blood pressure (SBP) associates with adverse kidney and cardiovascular events remains incompletely understood.

Methods: This study included participants in 2 clinical trials that compared intensive (<120 mm Hg) and standard (<140 mm Hg) SBP lowering. SBP-TTR for months 0 to 3 was calculated using therapeutic ranges of 110 to 130 mm Hg and 120 to 140 mm Hg for the intensive and standard arms, respectively. Adverse kidney events included the composite of dialysis, kidney transplant, serum creatinine >3.3 mg/dL, sustained eGFR <15 mL/(min·1.73 m2), or sustained eGFR decline >40%. Adverse cardiovascular events included myocardial infarction, stroke, heart failure, and cardiovascular death. Adjusted Cox proportional hazards regression models were used to estimate the association between SBP-TTR and kidney and cardiovascular events.

Results: Participants with higher TTR were younger and less likely to have preexisting cardiovascular disease. Compared with participants with TTR of 0%, the risk of adverse kidney events was lower for participants with TTR of >0% to 43% (hazard ratio [95% CI], 0.57 [0.42-0.76]; P<0.001), 43% to <70% (0.57 [0.42-0.78]; P=0.001), 70% to <100% (0.53 [0.38-0.74]; P<0.001), and 100% (0.33 [0.20-0.57]; P<0.001) in fully adjusted models. The risk of major adverse cardiovascular events was lower for participants with TTR of >0% to 43% (0.66 [0.52-0.83]; P=0.001), 43% to <70% (0.70 [0.55-0.90]; P=0.005), 70% to <100% (0.65 [0.50-0.84]; P=0.001), or 100% (0.56 [0.39-0.80]; P=0.001) compared with those with TTR of 0%.

Conclusions: Higher SBP-TTR associates with lower risks of adverse kidney and cardiovascular events in adults with hypertension. SBP-TTR may be a potential therapeutic target and quality metric.

Keywords: blood pressure; cardiovascular disease; heart failure; hypertension; quality of health care.

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Figures

Figure 1.
Figure 1.. Association between systolic blood pressure time-in-target range and major adverse kidney and cardiovascular events
Restricted cubic splines were used to model the association between systolic blood pressure and adverse kidney and cardiovascular events. Incidence rate was adjusted for age, sex, race, history of coronary or peripheral atherosclerotic cardiovascular disease, current smoking status, body mass index, urine albumin-to-creatinine ratio, fasting plasma glucose, baseline systolic blood pressure and baseline eGFR. Dashed lines indicate 95% confidence intervals. aIR = adjusted incidence rate; SBP = systolic blood pressure; TTR = time-in-target range
See this image and copyright information in PMC

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