Sustained control of systolic blood pressure and resting heart rate within target ranges improve cardiovascular outcomes in patients with hypertension

Abstract Background Time in target range of systolic blood pressure (SBP) can predict major adverse cardiovascular events (MACE) in hypertensive patients and guidelines have endorsed time in target range (TTR) as a key monitoring tool for hypertension management. Elevated resting heart rate (RHR) is associated with an increased risk of cardiovascular (CV) events, whether synergistic control of SBP and RHR TTR could improve CV outcomes in patients with hypertension remained unknown. Purpose We aimed to determine whether sustained control of SBP and RHR within target ranges improve CV outcomes in patients with hypertension. Methods Using data from 9,138 participants in the Systolic Blood Pressure Intervention Trial (SPRINT), we defined TTR for SBP (intensive treatment: 110–130 mmHg; standard treatment: 120–140 mmHg) and RHR (60–80 bpm) via linear interpolation. Participants were stratified into four TTR groups: dual-high (DH: SBP-TTR ＞50% + RHR-TTR ＞50%), high-SBP/low-RHR (HS-LR), low-SBP/high-RHR (LS-HR), and dual-low (DL: both TTR ≤50%). Cox models assessed associations between TTR groups and outcomes, including primary outcome (myocardial infarction, non-MI acute coronary syndrome, stroke, heart failure, CV death), MACE, and all-cause mortality. Results Over a median follow-up of 3.95 years, 684 primary outcome, 460 MACE, and 459 deaths occurred. After multivariable adjustment, compared to the DL group, although prognostic benefit was achieved in both the HS-LR and LS-HR groups, with hazard ratios (HRs) of 0.491 (95% confidence interval CI: 0.388–0.623) and 0.762 (95% CI: 0.596–0.976), respectively, it was not as significant as in the DH group with 0.420 (95% CI: 0.337–0.524). Subgroup analyses revealed consistent trends across treatment arms in primary and MACE outcome, while pronounced benefits in intensive treatment group in all-cause mortality. Conclusion Sustained control of SBP and RHR within target ranges significantly reduced the risk of CV events and all-cause mortality in patients with hypertension, independent of mean and variability of SBP and RHR.