Long-Term Systolic Blood Pressure Time in Target Range and Cardiovascular Disease in Individuals With Hypertension

Previous post hoc analyses of clinical trials have suggested that a higher percentage of systolic blood pressure time in target range (SBP-TTR) was associated with a decreased risk of cardiovascular disease (CVD). However, there is limited evidence from large prospective cohort studies on the relationship between long-term SBP-TTR and the risk of CVD. The purpose of this study was to assess the association between long-term SBP-TTR and the risk of CVD in adults with hypertension. This study included 26,929 hypertensive patients (mean age 52.8 ± 10.7 years; 83.1% males), free of CVD at baseline from the Kailuan Study. Blood pressure was measured biennially from 2006 to 2012, and the SBP target range was defined as 120 to 140 mm Hg. SBP-TTR was calculated by the Rosendaal linear interpolation method. Incident CVD events were ascertained via the linkage of electronic health record data. During a median follow-up of 8.6 years, 2,565 CVD, including 472 myocardial infarction and 2,151 stroke cases were documented. Comparing the high SBP-TTR (75%-100%) with the low SBP-TTR (0%-25%) group, the multivariable HRs were 0.67 (95% CI: 0.59-0.76) for CVD, 0.76 (95% CI: 0.56-1.02) for myocardial infarction, and 0.64 (95% CI: 0.56-0.74) for stroke. In addition, the association between SBP-TTR and CVD risk was stronger among individuals aged <65 years than their older counterparts (P for interaction <0.001). A greater percentage of SBP-TTR was associated with a lower risk of CVD among patients with hypertension. These findings underscore the importance of maintaining SBP within the target range for the prevention of CVD among hypertensive individuals.