Blood Pressure Time in Target Range Within 24 Hours and Cardiovascular Diseases and Mortality: Perspectives From a Real-World Cohort Study

Abstract

Objective: To investigate the association of 24-hour, daytime, and nighttime ambulatory systolic blood pressure (SBP) time in target range (TTR) with the risk of cardiovascular disease (CVD) and mortality in real-world settings.

Patients and methods: Data were obtained from the Kailuan study. Systolic blood pressure TTR was calculated using linear interpolation, with 110 to 140 mm Hg as the target range. Cox regressions were performed to assess the associations of SBP TTR with outcomes.

Results: Among 5099 participants in this analysis, 396 cases of CVD (7.77%) and 490 cases of all-cause mortality (9.61%) occurred during a median follow-up of 6.96 years. After multivariable adjustment, each 1-SD increment in 24-hour SBP TTR was associated with an 11% lower risk of CVD (hazard ratio [HR], 0.89; 95% CI, 0.79 to 0.99; P=.008) and all-cause mortality (HR, 0.89; 95% CI, 0.81 to 0.98; P=.01). Consistently, each 1-SD increment in daytime SBP TTR was associated with 14% lower risk of CVD (HR, 0.86; 95% CI, 0.78 to 0.95; P=.005) and 13% lower risk of all-cause mortality (HR, 0.87; 95% CI, 0.79 to 0.95; P=.003). However, the associations for nighttime SBP TTR did not reach statistically significant levels.

Conclusion: Higher SBP TTR was associated with lower risk of CVD and mortality among Chinese adults in real-world settings. Efforts to attain SBP within 110 to 140 mm Hg over time may be an effective strategy to prevent CVD.