Diastolic and systolic blood pressure time in target range as a cardiovascular risk marker in patients with type 2 diabetes

Cheng, Yi; Wang, Dan; Yang, Yi; Miao, Ya; Shen, Weili; Tian, Jingyan; Sheng, Chang‐Sheng

doi:10.1016/j.diabres.2023.110831

Cited by 3 publications

(3 citation statements)

References 33 publications

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“… 40 Additionally, a report from the ACCORD BP trial revealed a significant association between DBP‐TTR and a decreased risk of MACEs in hypertension patients with type 2 diabetes. 7 Therefore, SBP‐TTR may be a potential therapeutic target and quality metric.…”

Section: Discussionmentioning

confidence: 99%

“…Yet, the significance of maintaining diastolic blood pressure (DBP) has been increasingly recognized in recent times. 7 …”

Section: Introductionmentioning

confidence: 99%

“… 9 Moreover, DBP‐TTR has been shown to be significantly associated with a reduced risk of major adverse cardiovascular outcomes in patients with hypertension and type 2 diabetes. 7 However, the effect of BP‐TTR on prognosis in the hypertensive population with frailty remains unclear. Therefore, this study aimed to estimate the association between BP‐TTR (SBP‐TTR and DBP‐TTR) and the prognosis among SPRINT participants with pre‐frailty or frailty status.…”

Section: Introductionmentioning

confidence: 99%

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Systolic and diastolic blood pressure time in target range and cardiovascular outcomes in patients with hypertension and pre‐frailty or frailty status

Zhu,

Yang,

Liu

2024

J of Clinical Hypertension

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In patients with hypertension and pre‐frailty or frailty, the influence of systolic (SBP) and diastolic blood pressure (DBP) time in target range (TTR) on clinical outcomes is unclear. Thus, we conducted a post hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT). Classifying 4208 participants into frail and non‐frail groups using a frailty index, the study calculated blood pressure time in target range (BP‐TTR) for the first three months using the Rosendaal method. The primary endpoint included a composite of nonfatal myocardial infarction (MI), acute coronary syndromes, stroke, acute decompensated heart failure (ADHF), and cardiovascular death. Relationships between BP‐TTR and outcomes were analyzed using Kaplan‐Meier curves, Cox models, and restricted cubic spline curves, with subgroup analysis for further insights. In a median follow‐up of 3.17 years, primary outcomes occurred in 6.7% of participants. Kaplan‐Meier analysis showed that a lower systolic blood pressure time in target range (SBP‐TTR) (0%–25%) correlated with an increased cumulative incidence of the primary outcome (p < .001), nonfatal MI (P = .021), stroke (P = .004), and cardiovascular death (P = .002). A higher SBP‐TTR (75%–<100%) was linked to a reduced risk of these outcomes. The restricted cubic spline (RCS) curve revealed a linear association between SBP‐TTR and the primary outcome (non‐linear P = .704). Similar patterns were observed for diastolic blood pressure time in target range (DBP‐TTR). Subgroup analysis showed that the protective effect of higher SBP‐TTR was less pronounced at low DBP‐TTR levels (P for interaction = .023). In conclusion, this study highlights the importance of maintaining BP within the target range to mitigate cardiovascular risks in this population.

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Section: Discussionmentioning

confidence: 99%

“…Yet, the significance of maintaining diastolic blood pressure (DBP) has been increasingly recognized in recent times. 7 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Systolic and diastolic blood pressure time in target range and cardiovascular outcomes in patients with hypertension and pre‐frailty or frailty status

Zhu,

Yang,

Liu

2024

J of Clinical Hypertension

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Blood pressure time at target and its prognostic value for cardiovascular outcomes: a scoping review

Li,

Gnanenthiran,

Schutte

et al. 2024

Hypertens Res

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The proportion of time that blood pressure (BP) readings are at treatment target levels, commonly referred to as time at target or time in therapeutic range (BP-TTR), is emerging as a useful measure for evaluating hypertension management effectiveness and assessing longitudinal BP control. However, method of determination for BP-TTR differs across studies. This review identifies variations in BP-TTR determination methodologies and its potential prognostic value for cardiovascular outcomes. Following PRISMA extension for scoping reviews guidelines, literature was systematically searched in Embase, PubMed, Scopus, Web of Science, and CINAHL. Relevant clinical trials, observational studies, cohort studies, cross-sectional studies, and systematic reviews published in English were screened. Of 369 articles identified, 17 articles were included. Studies differed in the BP targets used (e.g., BP < 140/90 mmHg or 130/80 mmHg; systolic BP within 110–130 mmHg or 120–140 mmHg), BP-TTR measurement duration (range 24 h to 15 years), and calculation method (linear interpolation method, n = 12 [71%]; proportion of BP readings at target, n = 5 [29%]). Regardless of method, studies consistently demonstrated that higher BP-TTR was associated with reduced risk of cardiovascular outcomes. Six of eight studies found the association was independent of mean achieved BP or last measured BP. Despite variation in methods of BP-TTR determination, these studies demonstrated the potential prognostic value of BP-TTR for cardiovascular outcomes beyond current BP control measures. We recommend standardization of BP-TTR methodology, with preference for linear interpolation method when BP measurements are few or less frequent, and proportion of BP readings method when large number of BP readings are available.

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Time in Target Blood Pressure Range for the Prediction of Atrial Fibrillation in Treated Hypertension

Xia,

Zhang,

Wang

2023

Hypertension

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Diastolic and systolic blood pressure time in target range as a cardiovascular risk marker in patients with type 2 diabetes

Cited by 3 publications

References 33 publications

Systolic and diastolic blood pressure time in target range and cardiovascular outcomes in patients with hypertension and pre‐frailty or frailty status

Systolic and diastolic blood pressure time in target range and cardiovascular outcomes in patients with hypertension and pre‐frailty or frailty status

Blood pressure time at target and its prognostic value for cardiovascular outcomes: a scoping review

Time in Target Blood Pressure Range for the Prediction of Atrial Fibrillation in Treated Hypertension

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