Abstract FR465: Long-Term Systolic Blood Pressure Time in Target Range and Risk of Cardiovascular Disease Events in Community-Dwelling Older Adults

Blood pressure (BP) is a dynamic entity, but BP control is typically judged from a single clinical visit or an average across multiple visits. Single visit BPs may not accurately reflect BP control over time, and an average BP can be within a target range even if none of its contributing measurements fall within that range. Time in target range (TTR) is a newer metric of BP control which encapsulates both average BP and BP variability over time to reflect the consistency of effective BP control. High TTR has been independently associated with lower risk of cardiovascular disease (CVD) events; however, prior research has been conducted almost exclusively in middle-aged hypertensives, or within hypertension intervention trials, and used TTR estimates over relatively short time periods (3 to 6 months) rather than long-term (yearly), prior to outcome ascertainment. Thus, the utility of long-term TTR has not been specifically evaluated in a general older-aged cohort of treated and untreated individuals. To address this gap, we performed a post-hoc analysis of 16,753 community-dwelling adults (mean age=74 years) without prior CVD enrolled in the ASPirin in Reducing Events in the Elderly study. Cumulative systolic BP TTR was calculated in each participant using the visit averages of triplicate BPs obtained at baseline and the first and second annual study visits. Cox proportional hazards models, adjusted for important covariates including baseline systolic BP, were used to examine TTR for two systolic BP targets (<140, <130 mmHg) and time to adjudicated incident CVD and major adverse cardiovascular events (MACE) occurring after the TTR index period. Participants with TTRs of 0% or 100% were categorized separately, with 0% as the reference group, and remaining participants were grouped into tertiles using linear interpolation to estimate TTR. TTR was also defined discreetly by the number of study visits at each of the two BP targets. Our results (Table) consistently showed that 100% TTR for systolic BP<140 mmHg was independently associated with approximately 20% lower risk of CVD and MACE, and for systolic BP<130 mmHg was associated with 19-42% lower risk. Results were consistent for participants treated with, and without, antihypertensives (data not shown). We conclude that long-term TTR is a useful metric to evaluate BP control in a general population of older adults, and our findings emphasize the importance of sustained BP control to lower risk of CVD.