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

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 m 2 ), 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.