Systolic Blood Pressure Time in Target Range and Cardiovascular Outcomes in Patients With Hypertension
Open accessAbstract
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.
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The SPRINT trial showed that time spent within target BP levels was significantly associated with a lower risk of major adverse cardiovascular events, independent of average systolic BP levels.
“This finding was confirmed in the SPRINT trial30, which demonstrated that the time spent within target BP levels was significantly associated with a decreased risk of major adverse cardiovascular events, independent of average systolic BP levels.”
From Blood pressure and its variability: classic and novel measurement techniques (2022) · cites this paper as [30]
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- Authors
- Fatani, N., Dixon, D. L., Van Tassell, B. W., Fanikos, J., & Buckley, L. F.
- Affiliations
- Brigham and Women's Hospital (US)
- Virginia Commonwealth University (US)
- Corresponding author
- Buckley, Leo F.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2021-03
- Volume
- 77
- Issue
- 10
- Pages
- 1290-1299
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC7959178
- OpenAlex
- W3135026334
- Cited by
- 173
- References
- 12
- Citations by year
- 2026: 38 · 2025: 40 · 2024: 33 · 2023: 25 · 2022: 25 · 2021: 12
- FWCI
- 15.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American College of Clinical Pharmacy Research Institute
- National Heart, Lung, and Blood Institute
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- time in range, systolic blood pressure, hypertension, major adverse cardiovascular events, blood pressure variability, intensive blood pressure control, SPRINT trial, cardiovascular risk prediction, antihypertensive therapy
- MeSH terms
- Aged, Antihypertensive Agents, Blood Pressure, Female, Humans, Hypertension, Male, Middle Aged, Retrospective Studies
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