Blood pressure Time in Target Range and Clinical Outcomes in Chronic Kidney Disease

BACKGROUND: We examined the association between blood pressure (BP) time in target range and clinical outcomes in chronic kidney disease (CKD). METHODS: In 1908 participants in the Chronic Renal Insufficiency Cohort study who had BP measured at each visit for the first five years of the study, BP time in target range was defined as the percentage of visits with BP < 130/80 mmHg between baseline and year 5; and categorized into three groups (<25%, 25% to 75% and >75% of visits in target). Outcomes included cardiovascular events, kidney outcomes and mortality occurring after the year 5 visit. RESULTS: BP was in target range < 25% of visits in 430 (22.5%) participants; 909 (47.6%) participants had BP in target range 25-75% of visits, and 569 (29.8%) participants had BP in target range > 75% of visits. Participants with BP in target range at < 25% of visits had higher risks of subsequent cardiovascular events (Hazard Ratio HR 1.76, 95% Confidence Intervals 1.28-2.41), kidney outcomes (HR 2.25, 1.66-3.05), and all-cause mortality (HR 1.54, 1.21-1.97) compared with those controlled at > 75% of visits Participants with BP in target range at 25-75% of visits had higher risks of subsequent cardiovascular events (HR 1.46, 1.12-1.89), and kidney outcomes (HR 1.55, 1.21-1.98), compared with those controlled at > 75% of visits. CONCLUSIONS: Participants with CKD with lower BP time in target range over a five year period had a higher risk of subsequent renal and cardiovascular outcomes.