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.
Wang B, Li J, et al. • Journal of the American Heart Association • 2026
Better long-term systolic blood pressure control, assessed by time in target range, was independently associated with lower risks of renal function decline and long-term death in patients with heart failure.
Key Findings
Results
Each 1-SD increase in systolic blood pressure TTR (35–36%) was associated with a significantly lower risk of renal function decline in heart failure patients.
Odds ratio for renal function decline: 0.74 (95% CI, 0.60–0.93); P=0.008
Association was independent after multivariable adjustment
Renal function decline was defined as ≥20% reduction in eGFR from 1 to 12 months plus eGFR <60 mL/min per 1.73 m² at 12 months
Analysis included 1,529 patients with median follow-up of 1.0 year
Renal function decline decreased significantly from the lowest to highest TTR tertile (P-trend <0.001)
Results
Each 1-SD increase in systolic blood pressure TTR was associated with a significantly lower risk of 5-year all-cause death in heart failure patients.
Hazard ratio for all-cause death: 0.90 (95% CI, 0.83–0.98); P=0.01
Association was independent after multivariable adjustment
Analysis included 2,195 patients with median follow-up of 4.2 years
Death decreased significantly from the lowest to highest TTR tertile (P-trend=0.009)
Results were also consistent for cardiovascular death
Methods
The target systolic blood pressure range used for TTR calculation was 110 to 130 mm Hg, measured at 1, 6, and 12 months after hospital discharge.
TTR was calculated using linear interpolation over the 12-month post-discharge period
Systolic blood pressure was measured at 1, 6, and 12 months after discharge
1 SD of TTR corresponded to approximately 35%–36%
A 6-month TTR analysis was also conducted and yielded consistent results
Study enrolled patients hospitalized for heart failure across 52 hospitals in China between 2016 and 2018 (ClinicalTrials.gov: NCT02878811)
Results
The associations between higher TTR and lower risks of renal function decline and death were supported by restricted cubic spline analyses, indicating a dose-response relationship.
Restricted cubic spline analyses confirmed the trend observed in tertile analyses
Both renal function decline and death outcomes showed significant trends across TTR tertiles
P-trend for renal function decline <0.001; P-trend for death =0.009
Results were consistent across prespecified subgroup analyses
Methods
The study was a multicenter prospective cohort of patients hospitalized for heart failure across 52 hospitals in China.
Patients were enrolled between 2016 and 2018
1,529 patients were included in the renal function decline analysis and 2,195 in the death analysis
The cohort was a multicenter prospective design, reducing single-center bias
The study was registered at ClinicalTrials.gov (NCT02878811)
What This Means
This research suggests that keeping blood pressure within a specific target range over time — between 110 and 130 mm Hg systolic — is associated with better kidney health and longer survival in people hospitalized for heart failure. The study tracked over 2,000 patients across 52 hospitals in China, measuring their blood pressure at 1, 6, and 12 months after discharge. Researchers calculated what proportion of that year each patient spent with their blood pressure in the healthy target range, a measure called 'time in target range' (TTR).
The findings showed that patients who spent more time with their blood pressure in the target range had meaningfully lower odds of kidney function declining over the following year, and lower risk of dying over five years. Specifically, for every standard deviation increase in TTR (about 35–36 percentage points more time in range), the odds of significant kidney decline dropped by 26%, and the risk of death dropped by 10%. These associations held up even after accounting for other health factors, and were consistent whether researchers looked at 6-month or 12-month blood pressure data.
This research suggests that the consistency of blood pressure control — not just whether a single reading looks normal — may matter significantly for outcomes in heart failure patients. Managing blood pressure so that it stays steadily within an appropriate range over months could be an important goal in the care of people with heart failure, potentially helping protect kidney function and extend life. However, the study is observational, meaning it cannot definitively prove that improving TTR directly causes better outcomes.
Wang B, Li J, Huang X, Liu J, Zheng X, Li Y, et al.. (2026). 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.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.048006