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. 2025 May 19:1-12.
doi: 10.1159/000546380. Online ahead of print.

Time in Target Range of Systolic Blood Pressure and Cardiovascular Disease in Patients with Chronic Kidney Disease: A Korean Nationwide Cohort Study

Soo-Young Yoon  1 , Su Jin Jeong  2 , Jin Sug Kim  3 , Hyeon Seok Hwang  3 , Kyunghwan Jeong  3
Affiliations

Time in Target Range of Systolic Blood Pressure and Cardiovascular Disease in Patients with Chronic Kidney Disease: A Korean Nationwide Cohort Study

Soo-Young Yoon et al. Am J Nephrol. .

Abstract

Introduction: Time in target range of systolic blood pressure (SBP-TTR) is the percentage of time that the SBP remains within 110-130 mm Hg. The association between the SBP-TTR and clinical outcomes in patients with chronic kidney disease (CKD) remains unclear. We evaluated the risks of cardiovascular disease (CVD), all-cause mortality, and renal events across the SBP-TTR groups.

Methods: Overall, 193,289 patients with CKD who underwent at least two health checkups between 2012 and 2015 were selected from the Korean National Health Insurance Database. The patients were categorized into three categories based on their SBP-TTR levels: 76-100%, 26-75%, and 0-25%. The primary outcome was CVD risk and the secondary outcomes were all-cause mortality and progression to end-stage kidney disease (ESKD) according to SBP-TTR using Cox regression analysis.

Results: Compared with patients with SBP-TTR of 76-100%, the adjusted hazard ratios (HRs) for CVD were 1.07 (95% confidence interval [CI], 1.03-1.10) and 1.09 (95% CI: 1.06-1.13) for patients with SBP-TTR of 26-75%, and 0-25%, respectively. The adjusted HR for all-cause mortality was 1.04 (95% CI: 1.003-1.07) and 1.37 (95% CI: 1.28-1.46) for patients with SBP-TTR of 26-75% and 0-25%, respectively. The adjusted HRs for ESKD progression increased gradually: 1.14-fold (95% CI: 1.07-1.21) for the SBP-TTR 26-75% group and 1.37-fold (95% CI: 1.28-1.46) for the SBP-TTR 0-25% group. For patients not taking antihypertensive medications, a lower SBP-TTR was associated with a higher risk of CVD events and ESKD progression than in those taking antihypertensive medications.

Conclusion: Among patients with CKD, those with a lower SBP-TTR had a higher risk of cardiovascular events, mortality, and progression to ESKD.

Keywords: All-cause mortality; Cardiovascular disease; Chronic kidney disease; End-stage kidney disease; Time in target range.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Flow diagram of the study population. After exclusion, a total of 193,289 adults with CKD were included in the final study population. CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate.
Fig. 2.
Fig. 2.
Kaplan-Meier curves according to SBP-TTR categories in CKD population. The SBP-TTR categories were SBP-TTR 76–100%, SBP-TTR 25–75%, and SBP-TTR 0–25%. a CVD. b All-cause mortality. c ESKD. SBP-TTR, time in target range of systolic blood pressure.
Fig. 3.
Fig. 3.
Stratified analysis according to predefined subgroups on CVD, all-cause mortality, and ESKD. The SBP-TTR categories were SBP-TTR 76–100%, SBP-TTR 25–75%, and SBP-TTR 0–25%. a CVD. b All-cause mortality. c ESKD. The data were adjusted for age, sex, BMI, low-density lipoprotein cholesterol, hemoglobin, smoking, alcohol consumption, physical activity, Charlson Comorbidity Index score, estimated glomerular filtration rate, and proteinuria. CI, confidence interval; HR, hazard ratio; SBP-TTR, time in target range of systolic blood pressure.
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References

    1. Cockwell P, Fisher L-A. The global burden of chronic kidney disease. Lancet. 2020;395(10225):662–4. - PubMed
    1. Chen TK, Knicely DH, Grams ME. Chronic kidney disease diagnosis and management: a review. JAMA. 2019;322(13):1294–304. - PMC - PubMed
    1. Cheung AK, Chang TI, Cushman WC, Furth SL, Hou FF, Ix JH, et al. Executive summary of the KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int. 2021;99(3):559–69. - PubMed
    1. Yoon SY, Kong JY, Jeong SJ, Kim JS, Hwang HS, Jeong K. Association of the intensive blood pressure target and cardiovascular outcomes in the population with chronic kidney disease: a retrospective study in Korea. J Am Heart Assoc. 2024;13(6):e032186. - PMC - PubMed
    1. Ruggenenti P, Perna A, Loriga G, Ganeva M, Ene-Iordache B, Turturro M, et al. Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease (REIN-2): multicentre, randomised controlled trial. Lancet. 2005;365(9463):939–46. - PubMed