Improved Long‐Term Systolic Blood Pressure Control Measured by Time in Target Range Is Associated With Lower Risks of Renal Function Decline and Long‐Term Death Among Patients With Heart Failure

Background Heart failure is associated with renal function decline and increased morbidity and death. We evaluated the association of systolic blood pressure control over time, measured by time in target range (TTR), with renal function decline and death in patients with heart failure. Methods We analyzed a multicenter prospective cohort of patients hospitalized for heart failure across 52 hospitals in China between 2016 and 2018. Systolic blood pressure was measured at 1, 6, and 12 months after discharge. The 12‐month systolic blood pressure TTR was calculated by linear interpolation for a target range of 110 to 130 mm Hg. Outcomes were 1‐year renal function decline (≥20% reduction in estimated glomerular filtration rate from 1 to 12 months plus estimated glomerular filtration rate <60 mL/min per 1.73 m 2 at 12 months) and 5‐year all‐cause death. Results The analysis included 1529 patients for renal function decline and 2195 patients for death. Median follow‐up was 1.0 and 4.2 years, respectively. Renal function decline and death decreased significantly from the lowest to highest TTR tertile ( P trend <0.001 and 0.009, respectively), supported by restricted cubic spline analyses. After multivariable adjustment, each 1‐SD increase in TTR (35%–36%) was associated with lower risks of renal function decline (odds ratio, 0.74 [95% CI, 0.60–0.93]; P =0.008) and all‐cause death (hazard ratio, 0.90 [95% CI, 0.83–0.98]; P =0.01). Results were consistent across subgroups, using 6‐month TTR, and for cardiovascular death. Conclusions Better long‐term systolic blood pressure control, assessed by TTR, was independently associated with lower risks of renal function decline and long‐term death in patients with heart failure. Registration Information clinicaltrials.gov Identifier: NCT02878811