Time in Target Range, All-Cause Mortality, and Cardiovascular Diseases

Time in target range (TTR) of systolic blood pressure (SBP) is a concept characterizing the extent of blood pressure (BP) control. We aimed to compare the risk of all-cause mortality and cardiovascular diseases (CVDs) in participants with >50% time of their SBP within different target ranges.

A total of 40,914 participants who had complete BP data and were free of CVDs or cancer were included. Four SBP records over 6 years were used to calculate TTR and mean levels of covariates. The death and CVD events were recorded via reviewing medical records and death certificates.

During a median follow-up period of 8.78 (interquartile range: 8.50-9.05) and 7.76 (interquartile range: 7.46-8.04) years, we identified 2,398 death cases and 1,995 incident CVDs, respectively. Participants who had >50% TTR >150 mm Hg had a higher risk of all-cause mortality (hazard ratio [HR]: 1.67, 95% confidence interval [CI]: 1.16, 2.41) than those with >50% TTR <120 mm Hg. The corresponding HR was 2.06 (95% CI: 1.37, 3.10) for incident CVDs. The increased risk of all-cause mortality and CVD events persisted when we adjusted the covariates measured at the 2012 visit or excluded coalminers, the hypotensive participants, the incident cases occurring the first 2 years, or who used BP-lowering drugs.

Our study suggested that >50% TTR in a high target range of SBP significantly predicted the occurrence of all-cause mortality and CVDs.