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Systolic blood pressure time-in-target range and kidney outcomes in patients with hypertension: Findings from the STEP trial

Year: 2026

Type: article

Abstract: BACKGROUND: Time-in-target range (TTR) of systolic blood pressure (SBP) is determined by the proportion of time during which the SBP remains within a defined optimal range. The study aims to explore the association between SBP TTR and the occurrence of chronic kidney disease (CKD) in hypertensive patients. METHODS: A post hoc analysis of data from the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial was performed. The STEP trial compared intensive (110 to <130 mmHg) and standard (130 to <150 mmHg) SBP interventions in hypertensive individuals. The SBP TTR was calculated from baseline to 6 months using 110-130 mmHg and 130-150 mmHg as the target ranges for the intensive and standard groups, respectively. The primary outcome for this study was the first occurrence of CKD (estimated glomerular filtration rate <60 mL·min -1 ·1.73m -2 ). Cox proportional regression models were used to assess the association between SBP TTR and renal outcomes. RESULTS: Overall, 4924 participants were included in this study. Participants with a higher SBP TTR were likely to have a higher baseline diastolic blood pressure. In fully adjusted models, a 1-standard deviation increase in SBP TTR was associated with a 10% lower risk of poor kidney outcomes (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.83-0.98). Compared with participants in the lowest TTR group (T1: 0 to <38%), those in the highest TTR tertile (T3: 81% to <100%) had a lower risk of renal outcomes (HR: 0.76; 95% CI: 0.61-0.94). Sensitivity analysis showed consistent results when considering the competing risk of death and a combined target range of 110-140 mmHg for SBP. CONCLUSIONS: A higher SBP TTR was associated with a lower risk of kidney events in adults with hypertension. Therefore, the SBP TTR may be considered a potential therapeutic target and quality metric. REGISTRATION: No. NCT03015311 at ClinicalTrials.gov.

Source: Chinese Medical Journal

DOI: 10.1097/cm9.0000000000004118

Authors: Miaomiao Zhuang, Xinyi Peng, Qirui Song, Jingjing Bai, Mengyue Yu, Jun Cai