Key result
Higher SBP time in target range linked to ~26% lower risk of renal decline per SD.
Why the study?
Heart failure is associated with renal function decline and increased morbidity and death, but the association of longitudinal systolic blood pressure control with these outcomes was unclear.
Does better systolic blood pressure control, measured by time in target range, reduce renal function decline and all-cause death in patients with heart failure?
Cohort (n=2,195)
Yes
Does better systolic blood pressure control, measured by time in target range, reduce renal function decline and all-cause death in patients with heart failure?
Odds Ratio: 0.74 (95% CI 0.6–0.93)
p-value: p=0.008
Better long-term systolic blood pressure control, assessed by time in target range, is independently associated with lower risks of renal function decline and long-term mortality in patients with heart failure.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“[The] findings underscore the importance of long-term BP management for renal protection and improving outcomes in patients with HF and supports TTR as a potential prognostic tool in HF care.”
Supports time-in-target SBP as a prognostic marker in heart failure; leaves open whether optimizing it improves renal or survival outcomes.
Background Heart failure is associated with renal function decline and increased morbidity and death. We evaluated the association of systolic blood pressure control over time, measured by time in target range (TTR), with renal function decline and death in patients with heart failure. Methods We analyzed a multicenter prospective cohort of patients hospitalized for heart failure across 52 hospitals in China between 2016 and 2018. Systolic blood pressure was measured at 1, 6, and 12 months after discharge. The 12‐month systolic blood pressure TTR was calculated by linear interpolation for a target range of 110 to 130 mm Hg. Outcomes were 1‐year renal function decline (≥20% reduction in estimated glomerular filtration rate from 1 to 12 months plus estimated glomerular filtration rate <60 mL/min per 1.73 m 2 at 12 months) and 5‐year all‐cause death. Results The analysis included 1529 patients for renal function decline and 2195 patients for death. Median follow‐up was 1.0 and 4.2 years, respectively. Renal function decline and death decreased significantly from the lowest to highest TTR tertile ( P trend <0.001 and 0.009, respectively), supported by restricted cubic spline analyses. After multivariable adjustment, each 1‐SD increase in TTR (35%–36%) was associated with lower risks of renal function decline (odds ratio, 0.74 [95% CI, 0.60–0.93]; P =0.008) and all‐cause death (hazard ratio, 0.90 [95% CI, 0.83–0.98]; P =0.01). Results were consistent across subgroups, using 6‐month TTR, and for cardiovascular death. Conclusions Better long‐term systolic blood pressure control, assessed by TTR, was independently associated with lower risks of renal function decline and long‐term death in patients with heart failure. Registration Information clinicaltrials.gov Identifier: NCT02878811
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Wang et al. (2026) conducted a cohort in Heart failure (n=2,195). Systolic blood pressure time in target range (TTR) vs. Lower TTR was evaluated on 1-year renal function decline (≥20% reduction in eGFR from 1 to 12 months plus eGFR <60 mL/min per 1.73 m2 at 12 months) (OR 0.74, 95% CI 0.60-0.93, p=0.008). Each 1-SD increase in systolic blood pressure time in target range was associated with lower risks of renal function decline (OR 0.74; 95% CI 0.60-0.93) and all-cause death (HR 0.90; 95% CI 0.83-0.98).
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