What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension (n=21855). Intervention: Time in target range of systolic blood pressure (SBP-TTR) vs. Lower SBP-TTR groups. Primary outcome: New-onset CVD and all-cause mortality (Risk reduction 31% (CVD) and 34% (mortality) in highest SBP-TTR group).

What does this research mean for the field?

In young and middle-aged adults with hypertension, maintaining a higher systolic blood pressure time in target range (120-140 mm Hg) progressively lowers the risk of new-onset cardiovascular disease and all-cause mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To explore the relationship between time in target range of systolic blood pressure and the risks of cardiovascular disease and all-cause mortality in younger adults with hypertension.

May 23, 2026

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

Key Result

Higher systolic blood pressure time in target range (120-140 mm Hg) was associated with up to a 31% decreased risk for new-onset CVD and a 34% decreased risk for all-cause mortality.

Key Points

To explore the relationship between time in target range of systolic blood pressure and the risks of cardiovascular disease and all-cause mortality in younger adults with hypertension.
Longitudinal analysis from the Kailuan study involving participants under 60 with hypertension.
Target range for systolic blood pressure defined as 120 to 140 mm Hg, assessed from 2006 to 2016.
Primary outcomes included new-onset cardiovascular disease and all-cause mortality through December 2022.
1,969 cardiovascular disease events and 1,290 all-cause deaths documented.
Higher time in target range associated with a 12%, 14%, and 31% reduced risk of new-onset cardiovascular disease across increasing groups.
Mortality rates decreased by 9%, 12%, and 34% with higher SBP time in target range.

Study Design

Type

Cohort (n=21,855)

Structured PICO

Does a higher time in target range of systolic blood pressure reduce new-onset cardiovascular disease and all-cause mortality in young and middle-aged adults with hypertension?

Population

21,855 young and middle-aged adults (under 60 years) with hypertension per 2018 ESC/ESH guidelines from the Kailuan study, 82.7% male. Key inclusion: underwent at least three health assessments from 2006 to 2016.

Intervention

Higher time in target range of systolic blood pressure (SBP-TTR), with target range defined as 120 to 140 mm Hg

Comparator

Lower time in target range of systolic blood pressure (SBP-TTR)

Outcome

New-onset cardiovascular disease (CVD) and all-cause mortality through December 2022hard clinical

In young and middle-aged adults with hypertension, maintaining systolic blood pressure within the target range of 120-140 mmHg for a greater proportion of time is associated with progressively lower risks of new-onset cardiovascular disease and all-cause mortality.

Main Result

Effect estimate: Risk reduction 31% (CVD) and 34% (mortality) in highest SBP-TTR group

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.

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