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.
Each 1-SD increase in SBP time in target range (TTR) was associated with a 20% lower risk of the composite outcome of death-censored graft loss or ≥50% decline in eGFR.
Higher SBP-TTR categories showed progressively lower risks of the composite graft outcome compared to the 0% TTR group.
SBP-TTR was not significantly associated with all-cause death after multivariable adjustment in either cohort.
Stronger associations between SBP-TTR and graft outcomes were observed in specific high-risk subgroups.
The association between SBP-TTR and graft outcomes was replicated in an independent multicenter cohort.
The study used a prospective observational cohort design with SBP-TTR calculated via linear interpolation of serial office blood pressure measurements.
This research suggests that kidney transplant patients whose blood pressure stays consistently within a target range of 110–130 mm Hg have substantially better kidney graft outcomes than those whose blood pressure is more erratic or outside this range. Rather than looking at a single blood pressure reading, the researchers measured what proportion of time (over the first two years after transplant) each patient's systolic blood pressure remained in this target zone—a concept called 'time in target range' (TTR). Among nearly 4,600 transplant recipients followed for a median of four years, those who spent the most time in the target range had about half the risk of serious graft problems (such as graft loss or a major drop in kidney function) compared to those who never achieved the target. The benefit appeared to follow a dose-response pattern: the more time spent in the target blood pressure range, the lower the risk of graft dysfunction. This pattern held across most patient subgroups, but was especially pronounced in higher-risk patients, such as those who received kidneys from deceased donors, older donors, female donors, or who had higher blood pressure at baseline. Importantly, the findings were confirmed in a second, independent group of 828 transplant patients, strengthening confidence in the results. However, blood pressure control in this range was not significantly associated with overall survival (death from any cause). This research suggests that maintaining steady, consistent blood pressure control within the 110–130 mm Hg range—rather than just achieving a target at a single visit—may be an important goal for protecting transplanted kidneys. The authors note that because this was an observational study, it cannot prove that better blood pressure control directly causes better graft outcomes, and they call for randomized controlled trials to confirm whether actively targeting this range improves outcomes for kidney transplant recipients.
Koh H, Kim H, Park C, Ryu J, Jung H, Kim M, et al.. (2026). Association Between Systolic Blood Pressure Time in Target Range and Graft Outcomes in Kidney Transplant Recipients: Result From KOTRY and KNOW-KT.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.048247