Systolic Blood Pressure Time in Target Range and Major Adverse Kidney and Cardiovascular Events

医学 不利影响 血压 内科学 危险系数 肾脏疾病 心肌梗塞 透析 心脏病学 冲程(发动机) 比例危险模型 心力衰竭 肌酐 置信区间 机械工程 工程类
作者
Leo F. Buckley,William L. Baker,Benjamin Van Tassell,Jordana B. Cohen,Omar S. Alkhezi,Adam P. Bress,Dave L. Dixon
出处
期刊:Hypertension [Lippincott Williams & Wilkins]
卷期号:80 (2): 305-313 被引量:9
标识
DOI:10.1161/hypertensionaha.122.20141
摘要

Background: Whether time-in-target range (TTR) for systolic blood pressure (SBP) associates with adverse kidney and cardiovascular events remains incompletely understood. Methods: This study included participants in 2 clinical trials that compared intensive (<120 mm Hg) and standard (<140 mm Hg) SBP lowering. SBP-TTR for months 0 to 3 was calculated using therapeutic ranges of 110 to 130 mm Hg and 120 to 140 mm Hg for the intensive and standard arms, respectively. Adverse kidney events included the composite of dialysis, kidney transplant, serum creatinine >3.3 mg/dL, sustained eGFR <15 mL/(min·1.73 m 2 ), or sustained eGFR decline >40%. Adverse cardiovascular events included myocardial infarction, stroke, heart failure, and cardiovascular death. Adjusted Cox proportional hazards regression models were used to estimate the association between SBP-TTR and kidney and cardiovascular events. Results: Participants with higher TTR were younger and less likely to have preexisting cardiovascular disease. Compared with participants with TTR of 0%, the risk of adverse kidney events was lower for participants with TTR of >0% to 43% (hazard ratio [95% CI], 0.57 [0.42–0.76]; P <0.001), 43% to <70% (0.57 [0.42–0.78]; P =0.001), 70% to <100% (0.53 [0.38–0.74]; P <0.001), and 100% (0.33 [0.20–0.57]; P <0.001) in fully adjusted models. The risk of major adverse cardiovascular events was lower for participants with TTR of >0% to 43% (0.66 [0.52–0.83]; P =0.001), 43% to <70% (0.70 [0.55–0.90]; P =0.005), 70% to <100% (0.65 [0.50–0.84]; P =0.001), or 100% (0.56 [0.39–0.80]; P =0.001) compared with those with TTR of 0%. Conclusions: Higher SBP-TTR associates with lower risks of adverse kidney and cardiovascular events in adults with hypertension. SBP-TTR may be a potential therapeutic target and quality metric.
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