Systolic Blood Pressure Time in Target Range and Acute Kidney Injury in Patients With Hypertension

Weihua Chen; Cheng Yang; Yitian Chen; Zi-Jin Li; Kai Guan; Jian‐Jun Li; Rongchong Huang

doi:10.1161/hypertensionaha.125.25511

October 9, 2025HypertensionOpen Access

Systolic Blood Pressure Time in Target Range and Acute Kidney Injury in Patients With Hypertension

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Why the study?

The association between systolic blood pressure time in target range and the risk of acute kidney injury remains unclear.

Does a higher systolic blood pressure time in target range (SBP TTR) reduce the risk of incident acute kidney injury in patients with hypertension and elevated cardiovascular risk?

Key Points

To assess the relationship between systolic blood pressure time in target range and the risk of acute kidney injury among individuals treated for hypertension.
Post hoc analysis of the randomized Systolic Blood Pressure Intervention Trial (SPRINT; NCT01206062) comparing intensive (<120 mm Hg) versus standard (<140 mm Hg) systolic blood pressure targets.
Time in target range was defined over 3 months as 110 to 130 mm Hg for the intensive arm and 120 to 140 mm Hg for the standard arm.
Competing risk models evaluated incident acute kidney injury as the primary outcome and injury severity via modified KDIGO criteria as the secondary outcome.
Higher systolic blood pressure time in target range was associated with a lower risk of incident acute kidney injury.
The protective relationship between higher time in target range and reduced acute kidney injury risk persisted independently of assigned treatment intensity.

Structured PICO

Does a higher systolic blood pressure time in target range (SBP TTR) reduce the risk of incident acute kidney injury in patients with hypertension and elevated cardiovascular risk?

P

Population

8,985 adults with hypertension and increased cardiovascular disease risk from the SPRINT trial (102 clinical sites across the United States and Puerto Rico), mean age 67.9±9.3 years, 35.4% female. Inclusion criteria: age ≥50 years, baseline SBP 130-180 mm Hg, and ≥1 CVD risk factor (clinical/subclinical CVD excluding stroke, CKD with eGFR 20 to <60 mL/min per 1.73 m², 10-year Framingham CVD risk ≥15%, or age ≥75 years). Major exclusions: diabetes, prior stroke, fasting proteinuria >1 g/d, polycystic kidney disease, congestive heart failure (symptoms or LVEF <35%), <2 BP measurements in the first 3 months, or an AKI event within the first 3 months.

I

Intervention

Higher systolic blood pressure time in target range (SBP TTR 59%–100%, or analyzed per 1-SD [31%] increase) over 3 months (and 6 months in sensitivity analysis), with target range defined as 110–130 mm Hg for the intensive-treatment arm (<120 mm Hg target) and 120–140 mm Hg for the standard-treatment arm (<140 mm Hg target).

C

Comparator

Lower systolic blood pressure time in target range (SBP TTR 0% to <59%) over 3 months within the respective intensive (<120 mm Hg) or standard (<140 mm Hg) blood pressure treatment arms.

O

Outcome

Incident acute kidney injury (AKI), defined using modified Kidney Disease: Improving Global Outcomes (KDIGO) criteria focused on serum creatinine levels.hard clinical

Limitations

Study population was drawn from a clinical trial with a highly structured BP management protocol, limiting BP variation and potentially biasing results toward the null.
The exposure window for TTR calculation was relatively short (limited to 3 months in the primary analysis and 6 months in the sensitivity analysis).
Did not examine the effect of individual antihypertensive drugs and doses on the occurrence of AKI due to prescription changes during follow-up.
Did not capture milder AKI events managed in outpatient settings, potentially underestimating total AKI burden.
Excluded patients with prior stroke or diabetes, limiting generalizability to the entire hypertensive population.

Implication

Maintaining a higher systolic blood pressure time in target range early in antihypertensive treatment is independently associated with a lower risk of incident acute kidney injury, particularly severe stages 2 or 3 AKI, regardless of whether intensive or standard blood pressure targets are pursued.

Abstract

BACKGROUND: Acute kidney injury (AKI) is a serious complication of hypertension management. However, the association between systolic blood pressure (SBP) time in target range (TTR) and the risk of AKI remains unclear. METHODS: This is a post hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial). Participants were randomly assigned to intensive (<120 mm Hg) or standard (<140 mm Hg) SBP treatment arms. SBP TTR was defined as 110 to 130 mm Hg for the intensive arm and 120 to 140 mm Hg for the standard arm over 3 months. The primary outcome was incident AKI. The secondary outcome was the severity of AKI based on the modified Kidney Disease: Improving Global Outcomes criteria. Competing risk models were used to estimate the relationship between SBP TTR and AKI. CONCLUSIONS: Higher SBP TTR was associated with a lower risk of AKI, independent of treatment intensity, underscoring the importance of sustained blood pressure management. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01206062.

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Cite This Study

Chen et al. (2025) studied this question.

synapsesocial.com/papers/69f29d5b1b51e2fbf0187558 https://doi.org/10.1161/hypertensionaha.125.25511

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Systolic Blood Pressure Time in Target Range and Acute Kidney Injury in Patients With Hypertension

Figures

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Systolic Blood Pressure Time in Target Range and Acute Kidney Injury in Patients With Hypertension

Figures

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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