Abstract 4144351: Association of Blood Pressure Time in Target Range with Outcomes Among NIH "All of Us” Cohort

Novel means to account for BP fluctuations are being scrutinized to assess longitudinal control, including BP time in target range (TTR) assessment. TTR quantifies the percentage of time a patient’s BP is in the desired range. The present analysis sought to determine the relationship between BP TTR and long-term outcomes among participants in the NIH “All of Us” cohort. Systolic and diastolic BP TTR are differentially associated with long-term outcomes among low-risk primary prevention participants compared to high-risk primary, as well as secondary prevention participants. “All of Us” is an 800,000 participant cohort that is followed longitudinally and collects demographics, adverse events, medications, procedures, and laboratory and clinical measurements. A participant’s systolic BP was noted to be in target range if it was between 110-130 mm Hg and diastolic BP was in target range if it was between 70-80 mmHg. TTR was calculated via traditional and Rosendaal linear interpolation (RLI) methods. Participants were grouped into high and low-risk primary and secondary prevention groups and sorted into four groups based on the percentage of TTR: <25%, 25–50%, 50-75%, or ≥75%. Descriptive statistics, hazard ratios, and survival curves were generated to assess the association between TTR and a composite outcome of major adverse cardiovascular events and all-cause mortality. 156,183 participants had at least 4 BP readings and were analyzed. The cohort had a mean systolic BP of 125 mm Hg and diastolic BP of 74 mm Hg. Among secondary prevention patients, a lower risk of the composite outcome was seen among individuals with ≥75% systolic TTR compared with <25% using the traditional (HR 0.48, CI(0.28, 0.81), p=0.006) and RLI (HR 0.49, CI(0.28, 0.87), p=0.014). In high-risk primary prevention participants, higher systolic BP TTR by RLI was associated with decreased risk and in low-risk primary prevention participants, higher systolic BP TTR by the traditional method was associated with decreased risk. Survival curves corroborated this trend (Figure). Diastolic BP TTR analysis demonstrated similar associations. Systolic and diastolic BP TTR predict long-term cardiovascular and all-cause mortality among the “All of Us” cohort.