Association between 24-hour systolic blood pressure time in target range and mortality

Journal article

Background:
Time in target range (TTR) reflects the proportion of time blood pressure (BP) remains within a defined range, integrating BP variability and control. We examined associations of systolic BP (SBP) TTR during ambulatory BP monitoring (ABPM) with cardiovascular (CV) and all-cause mortality.

Methods:
Patients from the Spanish ABPM Registry who were receiving antihypertensive medications or who had sustained or masked hypertension without treatment, defined by office BP ≥140/90 mmHg and 24-hour BP ≥130/80 mmHg. TTR was estimated by linear interpolation between consecutive SBP recordings obtained from ABPM and expressed as the proportion of time SBP remained within 120-134 mmHg during daytime and 110-119 mmHg during nighttime, from which 24-hour TTR was derived. Associations with mortality were assessed by Cox regression adjusted for demographic and clinical variables.

Results:
A total of 48,687 patients (46% women) were analyzed. Over a median follow-up of 9.7 years, 6,502 deaths occurred, including 2,185 CV deaths. Higher 24- hour TTR was associated with lower all-cause mortality (HR 0.83 per 1-SD increment; 95% CI 0.80-0.85). Similarly, higher 24-hour TTR was associated with lower CV mortality (HR 0.80 per 1-SD increment; 95% CI 0.76-0.84). Both associations remained significant after adjusting for mean 24-hour SBP and SBP variability.

Conclusions:
Higher 24-hour SBP TTR derived from ABPM was independently associated with lower all-cause and CV mortality.

Authors: Lauder, L; Schwantke, I; de la Sierra, A; Vinyoles, E; Gorostidi, M

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: American Heart Association
• Journal: Hypertension
• Volume: 83
• Article number: e26112
• Publication date: 2026-02-27
• Acceptance date: 2026-02-09
• DOI: 10.1161/HYPERTENSIONAHA.125.26112
• EISSN: 1524-4563
• ISSN: 0194-911X
• Language: English
• Keywords: ambulatory blood pressure monitoring; hypertension; all-cause mortality; cardiovascular mortality; blood pressure variability