Increased time in systolic target range during 24-hour ambulatory blood pressure monitoring was associated with a lower risk of all-cause death (HR 0.83 per 1SD increment; 95% CI 0.80-0.85).
Cohort (n=59,124)
Yes
Does increased time in systolic target range during 24-hour ambulatory blood pressure monitoring reduce all-cause mortality?
Greater time in systolic blood pressure target range during 24-hour ambulatory monitoring is independently associated with reduced all-cause mortality, highlighting the importance of consistent blood pressure control beyond just mean blood pressure values.
Hazard Ratio: 0.83 (95% CI 0.8–0.85)
Abstract Background/Introduction Time in target range (TTR) reflects the proportion of time that blood pressure (BP) is within target range over various time points and therefore comprises information on BP variability and control. Purpose To examine the association of TTR for systolic BP (SBP) during 24-hour ambulatory BP monitoring (24h-TTR) with all-cause mortality. Methods This analysis utilized data from the Spanish ABPM Registry, including patients from 223 primary care centres across all 17 regions of Spain. Mortality data was obtained from a computerized search of the vital registry of the Spanish National Institute of Statistics. The 24h-TTR was calculated using linear interpolation between two consecutive SBP recordings obtained from ABPM and determined the proportion of time spent in the TTR defined as a SBP of 120-134 mmHg during daytime and SBP of 110-119 mmHg during night-time. Association with all-cause mortality was assessed by Cox regression models adjusted for demographic and clinical. Results A total of 59,124 patients (47% female, mean age 58.7 years SD 14.1) were included in the Spanish ABPM Registry. The mean 24h-SBP was 128.8 mmHg (13.7). The mean 24h-TTR was 30.7% (SD 16.8), ranging from 0% to 87.8% (34.3% SD 19.9 during waking and 23.7% SD 19.5 during sleeping periods). During a median follow-up of 9.7 years, 7,174 (12.1%) of 59,124 patients died, including 2,361 (4.0%) from CV causes. Increased 24h-TTR was associated with a lower risk of all-cause death (hazard ratio HR 0.83 per 1SD increment 95% CI 0.80-0.85). This association remained significant even after additionally adjusting for mean 24h-SBP (HR 0.89 per 1SD increment [95% CI (0.86-0.92). The association of 24h-TTR with all-cause death was not significant in patients with a mean 24h-SBP of 115 mmHg (p=0.5205) but in those with 115-129 mmHg (p0.0001), and ≥130 mmHg (p=0.0001) (Figure). Conclusion Increased 24h-TTR was associated with a lower risk of all-cause death, particularly in patients with controlled and elevated mean 24h-SBP.
Lauder et al. (Sat,) conducted a cohort in Patients undergoing ambulatory blood pressure monitoring (n=59,124). Time in systolic target range during 24-hour ambulatory BP monitoring (24h-TTR) vs. Lower 24h-TTR was evaluated on All-cause mortality (HR 0.83, 95% CI 0.80-0.85). Increased time in systolic target range during 24-hour ambulatory blood pressure monitoring was associated with a lower risk of all-cause death (HR 0.83 per 1SD increment; 95% CI 0.80-0.85).