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August 22, 2026Journal of the American Heart AssociationOpen Access

Association Between Systolic Blood Pressure Time in Target Range and Graft Outcomes in Kidney Transplant Recipients: Result From KOTRY and KNOW‐KT

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Why the study?

Time in target range for blood pressure reflects consistency of control and may better predict outcomes, motivating evaluation of SBP-TTR and graft outcomes in kidney transplant recipients.

Does higher systolic blood pressure time in target range (110-130 mm Hg) prevent graft dysfunction in kidney transplant recipients?

Population

4559 kidney transplant recipients in KOTRY and 828 in KNOW-KT

Comparison

Different levels of SBP-TTR within 110 to 130 mm Hg

Design

Prospective observational cohort study

Follow-up

Median 4 years

Authors

HKHee Byung KohHKHyo Jeong KimCPCheol Ho Park

Discussion

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Overview

SBP-TTR may aid risk stratification post-kidney transplant; leaves open whether TTR-guided BP management improves graft outcomes.

Key Points

  • Determine the association between systolic blood pressure time in target range (110 to 130 mm Hg) and graft outcomes in kidney transplant recipients.
  • Analyzed prospective observational cohort data from 4,559 kidney transplant recipients in the nationwide KOTRY registry and 828 recipients in the multicenter KNOW-KT replication cohort in South Korea over a median follow-up of 4 years.
  • Calculated SBP-TTR (110–130 mm Hg) via linear interpolation from office blood pressure readings taken at 6, 12, and 24 months post-transplantation (12, 24, and 36 months in KNOW-KT).
  • Evaluated a primary composite outcome of death-censored graft loss or a ≥50% decline in estimated glomerular filtration rate.
  • Each 1-SD increase in SBP-TTR was associated with a 20% lower risk of the primary composite outcome (aHR, 0.80 [95% CI, 0.71–0.91]).
  • Compared to the 0% SBP-TTR group, composite outcome risk was progressively lower in the 1%–50% (aHR, 0.69 [95% CI, 0.50–0.95]), 51%–99% (aHR, 0.63 [95% CI, 0.46–0.87]), and 100% SBP-TTR groups (aHR, 0.47 [95% CI, 0.31–0.71]).
  • All-cause mortality was not significantly associated with SBP-TTR after multivariable adjustment (aHR per 1-SD increase, 0.88 [95% CI, 0.71–1.09]).

Structured PICO

Does higher systolic blood pressure time in target range (110-130 mm Hg) prevent graft dysfunction in kidney transplant recipients?

P
Population
5,387 kidney transplant recipients (4,559 from the nationwide KOTRY main cohort and 828 from the multicenter KNOW-KT replication cohort)
I
Intervention
Higher systolic blood pressure time in target range (SBP-TTR) within 110 to 130 mm Hg
C
Comparator
Lower SBP-TTR (e.g., 0% SBP-TTR group)
O
Outcome
Composite of death-censored graft loss or ≥50% decline in estimated glomerular filtration ratecomposite

Maintaining systolic blood pressure consistently within 110-130 mm Hg is associated with a significantly lower risk of graft dysfunction in kidney transplant recipients.

Cite This Study

Koh et al. (2026) studied this question.

synapsesocial.com/papers/6a895fc4ca7ade938187ea86https://doi.org/10.1161/jaha.125.048247
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