Can Time in Systolic BP Target Range Predict Adverse CV Events?

Time in systolic blood pressure (BP) target range may independently predict major adverse cardiovascular event risk, according to a study published March 8 in the Journal of the American College of Cardiology.

Nayyra Fatani, PharmD, et al., conducted a retrospective analysis of the SPRINT trial – a randomized controlled trial that compared intensive and standard systolic BP treatment interventions in adults with hypertension and high cardiovascular risk. Target range was defined as 110 to 130 mm Hg and 120 to 140 mm Hg for intensive and standard arms, respectively, and time in target range was estimated over the first three months of follow-up using linear interpolation.

Among the 6,162 patients included in the analysis, patients with greater time in the target range were younger, had lower 10-year cardiovascular risk, lower baseline systolic BP, and were more likely women and statin users. Researchers found that each 1-SD increase in time in target range was significantly associated with a decreased risk of first major adverse cardiovascular event.

"Time in target range may be a useful metric of [BP] control for population-based quality assessment and clinical trial interventions," the authors conclude.

George Bakris, MD, and Hillel Sternlicht, MD, write in an accompanying editorial comment, "[the study by Fatani et al.,] deepens our understanding of the benchmarks required to designate a patient's BP as 'controlled' and offers complete criteria to date for (prognostically) classifying BP values as 'optimal.' It reminds the physician that the patient's BP on the visit day should be compared to prior encounters and those measured during the initial [three] or [four] appointments. These data are also a clarion call for home BP monitoring and, by extension, the patient's ongoing responsibility for his/her care."

Clinical Topics: Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Nonstatins, Novel Agents, Statins, Hypertension

Keywords: Hydroxymethylglutaryl-CoA Reductase Inhibitors, Blood Pressure, Cardiovascular Diseases, Retrospective Studies, Benchmarking, Follow-Up Studies, Risk Factors, Blood Pressure Monitoring, Ambulatory, Hypertension, Systole, Cardiology, Reference Standards, Longitudinal Studies

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