Office blood pressure ‘time in target range’ is associated with an improvement in left ventricular mass index in patients with hypertension

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Abstract
Background . Time in target range (TTR) of blood pressure (BP) is a recently proposed and promising indicator of hypertension (HTN) control. According to several observational studies, TTR appears to have a stronger association with cardiovascular adverse events than snapshot achievement of target BP values. The left ventricular mass index (LVMI), reflecting structural cardiac remodeling, may serve as an additional surrogate endpoint for assessing the prognostic value of TTR. Objective . To determine the presence and strength of the association between longer clinical systolic BP (SBP) TTR and the change in LVMI over 12 months in patients with initially uncontrolled hypertension. Design and methods . This was a prospective, observational, single-center study involving patients of both sexes over the age of 18 with uncontrolled HTN (defined as receiving ≥ 1 antihypertensive medication) based on clinical BP measurements. The follow-up period was 12 months and included mandatory baseline, intermediate (3-month), and final visits for clinical BP assessment (3 visits total) and echocardiographic examinations (baseline and final visits). TTR was calculated using linear interpolation. Linear regression analysis was performed to identify predictors of ∆LVMI between the first and last visits. Results . Seventy-six patients with both baseline and final echocardiographic data were included (19 women; mean age 46 years). At baseline, mean clinical SBP was 156 ± 16 mmHg, and mean LVMI was 120 ± 23 g/m². By the end of follow-up, both SBP and LVMI significantly decreased (∆24 ± 15 mmHg, p < 0,001 and ∆5,5 g/m² [95 % confidence interval (CI): 1,5 to 9,5], p = 0,011). A total of 57 patients (75 %) achieved BP control. The mean TTR was 20,2 % (95 % CI: 13,3–27,0). Multiple linear regression analysis (adjusted R² = 0,72) revealed that TTR (β = −0,167, p = 0,021), higher baseline SBP (β = −0,428, p = 0,028), and absence of active smoking (β = −11,67, p = 0,029) were independent predictors of LVMI regression. Conclusions . In high-risk patients with initially uncontrolled hypertension and no serious complications, significant reductions in clinical SBP and LVMI were observed over 12 months. A longer TTR was independently associated with LVMI regression, irrespective of other clinical parameters, particularly ∆SBP. These findings suggest that not just BP reduction, but sustained maintenance of BP within the target range is a key factor in reversing target organ damage.

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