Systolic Blood Pressure Time in Target Range and Cardiovascular Outcomes in Patients With Hypertension

Abstract

Background: Standard blood pressure control metrics may not account for fluctuations in blood pressure over time.

Objectives: This study sought to estimate the independent association between time in systolic blood pressure target range and major adverse cardiovascular events among adults with hypertension.

Methods: This study was a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial), a randomized clinical trial that compared intensive (<120 mm Hg) and standard (<140 mm Hg) systolic blood pressure treatment interventions in adults with hypertension and high cardiovascular risk. Target range was defined as 110 to 130 mm Hg and 120 to 140 mm Hg for the intensive and standard arms, respectively. Time in target range was estimated over the first 3 months of follow-up using linear interpolation. The association between time in target range with major adverse cardiovascular events was estimated using adjusted Cox proportional hazards regression models.

Results: Participants with greater time in target range were younger, had lower 10-year cardiovascular risk and lower baseline systolic blood pressure, and were more likely women and statin users. Each 1-SD increase in time in target range was significantly associated with a decreased risk of first major adverse cardiovascular event in fully adjusted models. Time in target range remained significantly associated with major adverse cardiovascular events despite adjustment for mean systolic blood pressure or systolic blood pressure variability. Among participants with mean systolic blood pressure at or below target, time in target range remained associated with major adverse cardiovascular events.

Conclusions: Time in systolic blood pressure target range independently predicts major adverse cardiovascular event risk.

Keywords: hypertension; quality of care; time in target range.

Figure 1.. Relationships between Systolic Blood Pressure Time in Target Range, Mean Systolic Blood Pressure and Systolic Blood Pressure Standard Deviation.

The relationships between systolic blood pressure control measures are depicted separately for intensive and standard blood pressure lowering arms.

Central Illustration.. Systolic Blood Pressure Time in Target Range as an Independent Predictor of Cardiovascular Outcomes.

This figure depicts examples of high and low systolic blood pressure time in target range (left and right upper panels). Systolic blood pressure time in target range associates with a decreased risk of major cardiovascular outcomes after adjustment for cardiovascular risk factors and mean systolic blood pressure (lower panel).