Effects of Time in Target Range of Systolic Blood Pressure Control on New-Onset Cardiovascular Diseases and All-Cause Mortality in Young and Middle-Aged Adults with Hypertension

Donglei Luo; Hongmin Liu; Jingdi Zhang; Nan Zhang; Zhiqiang Zhao; Hui Wang; Yang Liu; Guodong Wang; Shuohua Chen; Enzhao Liu; Wenfeng Shangguan; Yubing Guo; Gary Tse; Shouling Wu; Tong Liu

doi:10.1093/ajh/hpag050

Effects of Time in Target Range of Systolic Blood Pressure Control on New-Onset Cardiovascular Diseases and All-Cause Mortality in Young and Middle-Aged Adults with Hypertension

Am J Hypertens. 2026 May 20:hpag050. doi: 10.1093/ajh/hpag050. Online ahead of print.

Authors

Donglei Luo^{1

2}, Hongmin Liu^{1

3}, Jingdi Zhang⁴, Nan Zhang¹, Zhiqiang Zhao¹, Hui Wang¹, Yang Liu⁵, Guodong Wang³, Shuohua Chen³, Enzhao Liu¹, Wenfeng Shangguan¹, Yubing Guo¹, Gary Tse^{1

6

7}, Shouling Wu³, Tong Liu¹

Affiliations

¹ Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
² Department of Cardiology, Chengde Central Hospital, Second Clinical College of Chengde Medical University, Chengde, 067000, China.
³ Department of Cardiology, Kailuan General Hospital, Tangshan, 063000, China.
⁴ School of Public Health, North China University of Science and Technology, Caofeidian Eco-city, Tangshan, 063000, China.
⁵ Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China.
⁶ School of Nursing and Health Sciences, Hong Kong Metropolitan University, Hong Kong, China.
⁷ Cardiovascular Analytics Group, PowerHealth Limited, Hong Kong, China.

PMID: 42162944
DOI: 10.1093/ajh/hpag050

Abstract

Background: The impact of the time target range of systolic blood pressure (SBP-TTR) on cardiovascular disease (CVD) and all-cause mortality has not yet been elucidated in the young and middle-aged adult subjects with hypertension. We detail the possible relationship between SBP-TTR and the risk of new-onset CVD and all-cause mortality among young and middle-aged adult subjects with hypertension.

Methods: A longitudinal analysis was conducted within the Kailuan study, involving participants under 60 with hypertension per 2018 ESC/ESH guidelines, who underwent at least three health assessments from 2006 to 2016. The target range for SBP was defined as 120 to 140 mm Hg. SBP-TTR was determined through linear interpolation of systolic blood pressure (SBP) measurements during health exams until 2017. Primary outcomes included new-onset CVD and all-cause mortality through December 2022.

Results: The cohort included 21,855 participants (82.7% male) with an average SBP of 144.59 mmHg. The average SBP-TTR was 39%. 1,969 CVD events and 1,290 all-cause deaths were documented. Higher SBP-TTR correlated with younger age, greater education, and improved kidney function. Increased SBP-TTR was associated with diminished new-onset CVD and lower all-cause mortality rates. Specifically, risks for CVD decreased by 12%, 14%, and 31%, and for mortality by 9%, 12%, and 34% across increasing SBP-TTR groups. A near-linear dose-response relationship was noted (P for non-linearity = 0.303), confirmed by sensitivity analyses. The stricter SBP control was associated with a lower incidence of CVD.

Conclusions: In middle-aged and younger adults with hypertension, a higher SBP time in target range is associated with progressively lower risks of new-onset CVD and all-cause mortality, underscoring the importance of sustained blood pressure control.

Keywords: all-cause mortality; cardiovascular diseases; hypertension; systolic blood pressure; time in target range.

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