Association Between Systolic Blood Pressure Time in Target Range and Graft Outcomes in Kidney Transplant Recipients: Result From KOTRY and KNOW‐KT

BACKGROUND: Time in target range (TTR) for blood pressure reflects the consistency of blood pressure control and may better predict outcomes than single measurements. We examined the association between systolic blood pressure (SBP)-TTR and graft outcomes in kidney transplant recipients. METHODS: We conducted a prospective observational cohort study including 4559 kidney transplant recipients from the nationwide KOTRY (Korean Organ Transplantation Registry; main cohort) and 828 from the multicenter KNOW-KT (Korean Cohort Study for Outcome in Patients With Kidney Transplantation; replication cohort). SBP-TTR within 110 to 130 mm Hg was calculated using linear interpolation of office blood pressure at 6, 12, and 24 months after transplantation (12, 24, and 36 months in the replication cohort). The primary outcome was a composite of death-censored graft loss or ≥50% decline in estimated glomerular filtration rate. RESULTS: Over a median follow-up of 4 years, each 1-SD increase in SBP-TTR was associated with a 20% lower risk of the composite outcome (adjusted hazard ratio [aHR], 0.80 [95% CI, 0.71-0.91]). Compared with the 0% SBP-TTR group, the 1% to 50%, 51% to 99%, and 100% SBP-TTR groups had progressively lower risks (aHRs, 0.69 [95% CI, 0.50-0.95]; 0.63 [95% CI, 0.46-0.87]; and 0.47 [95% CI, 0.31-0.71], respectively). Stronger associations were observed among recipients of deceased donor kidneys and those with older or female donors or a higher baseline SBP. The replication cohort showed similar associations. All-cause death was not significantly associated with SBP-TTR after multivariable adjustment in either the main cohort (aHR per 1-SD increase, 0.88 [95% CI, 0.71-1.09]) or the replication cohort. CONCLUSIONS: A higher proportion of time with SBP within the target range of 110 to 130 mm Hg was associated with a lower risk of graft dysfunction, with consistent effects across most subgroups and more pronounced benefits in high-risk populations. These findings suggest that sustained SBP control within this range may be clinically relevant in kidney transplant recipients; however, randomized controlled trials are needed to confirm causality and inform therapeutic strategies.

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Journal
Journal of the American Heart Association
Published
2026-08-20
DOI
https://doi.org/10.1161/jaha.125.048247
Primary Topic
Renal Transplantation Outcomes and Treatments
Type
article
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article

Association Between Systolic Blood Pressure Time in Target Range and Graft Outcomes in Kidney Transplant Recipients: Result From KOTRY and KNOW‐KT

Ji Hyun Yeom, Sang Hun Eum, Man Ki Ju, Beom Seok Kim et al.
Journal of the American Heart Association
Renal Transplantation Outcomes and Treatments
article

Association Between Systolic Blood Pressure Time in Target Range and Graft Outcomes in Kidney Transplant Recipients: Result From KOTRY and KNOW‐KT

Ji Hyun Yeom, Sang Hun Eum, Man Ki Ju, Beom Seok Kim, Seungyeup Han, Hee Byung Koh, Kyu Ha Huh, Hee‐Yeon Jung, Kyo Won Lee, Jung‐Hwa Ryu, Kyung Pyo Kang, Myung-Gyu Kim, Seok Hui Kang, Young Joo Kwon, Kipyo Kim, Sang Youb Han, Myoung Soo Kim, Jae Berm Park, Jieun Oh, Tae Hyun Ban, Cheol Ho Park, Dong Ryeol Lee, Sangil Min, Jaeseok Yang, Seunghyeok Choi, Su Woong Jung, Ki-Ryang Na, Hyo Jeong Kim, Yeong Hoon Kim, Jin Seok Jeon, Ji Yoon Choi, Sung Shin, Soo Jin Na Choi, Kyo Won Lee, Kyu Ha Huh, Joong Kyung Kim, Sik Lee, Byung Ha Chung, Myoung Soo Kim, Seungyeup Han, Yeon Ho Park, Ho Sik Shin, Seung Hwan Song, Jeonghwan Lee, Minyu Kang, Jeong‐Hoon Lee, Jong Soo Lee, Jong Cheol Jeong, Yu Ho Lee, Chan‐Duck Kim, Eun Jeong Ko, Woo Yeong Park, Su Hyung Lee, Seun Deuk Hwang, Sang Heon Song, Jaeseok Yang, Hee‐Yeon Jung, Hyun Jeong Kim, Jun Young Lee, Dong Won Lee, Cheol Woong Jung, Jung‐Hwa Ryu, Kook‐Hwan Oh
article en

Abstract

BACKGROUND: Time in target range (TTR) for blood pressure reflects the consistency of blood pressure control and may better predict outcomes than single measurements. We examined the association between systolic blood pressure (SBP)-TTR and graft outcomes in kidney transplant recipients. METHODS: We conducted a prospective observational cohort study including 4559 kidney transplant recipients from the nationwide KOTRY (Korean Organ Transplantation Registry; main cohort) and 828 from the multicenter KNOW-KT (Korean Cohort Study for Outcome in Patients With Kidney Transplantation; replication cohort). SBP-TTR within 110 to 130 mm Hg was calculated using linear interpolation of office blood pressure at 6, 12, and 24 months after transplantation (12, 24, and 36 months in the replication cohort). The primary outcome was a composite of death-censored graft loss or ≥50% decline in estimated glomerular filtration rate. RESULTS: Over a median follow-up of 4 years, each 1-SD increase in SBP-TTR was associated with a 20% lower risk of the composite outcome (adjusted hazard ratio [aHR], 0.80 [95% CI, 0.71-0.91]). Compared with the 0% SBP-TTR group, the 1% to 50%, 51% to 99%, and 100% SBP-TTR groups had progressively lower risks (aHRs, 0.69 [95% CI, 0.50-0.95]; 0.63 [95% CI, 0.46-0.87]; and 0.47 [95% CI, 0.31-0.71], respectively). Stronger associations were observed among recipients of deceased donor kidneys and those with older or female donors or a higher baseline SBP. The replication cohort showed similar associations. All-cause death was not significantly associated with SBP-TTR after multivariable adjustment in either the main cohort (aHR per 1-SD increase, 0.88 [95% CI, 0.71-1.09]) or the replication cohort. CONCLUSIONS: A higher proportion of time with SBP within the target range of 110 to 130 mm Hg was associated with a lower risk of graft dysfunction, with consistent effects across most subgroups and more pronounced benefits in high-risk populations. These findings suggest that sustained SBP control within this range may be clinically relevant in kidney transplant recipients; however, randomized controlled trials are needed to confirm causality and inform therapeutic strategies.

Journal of the American Heart Association
Ewha Womans University (KR), Yonsei University (KR), Korea University (KR), Kyungpook National University Hospital (KR), Samsung Medical Center (KR), Keimyung University Dongsan Medical Center (KR), Jeonbuk National University Hospital (KR), National Health Insurance Service Ilsan Hospital (KR), Yeungnam University Medical Center (KR), National Health Insurance Service (KR), Ewha Womans University Seoul Hospital (KR), Keimyung University (KR), Jeonbuk National University (KR), Sungkyunkwan University (KR), Catholic University of Korea (KR)
Good health and well-being
Openalex Percentile: Top 8%
Renal Transplantation Outcomes and Treatments
DOIOpen Access PDFOpenAlex
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