Chen WH, Yang C, Chen YT, Li ZJ, Guan K, Li JJ, Huang RC. Systolic Blood Pressure Time in Target Range and Acute Kidney Injury in Patients With Hypertension. Hypertension. 2025 Oct 9. doi: 10.1161/HYPERTENSIONAHA.125.25511. Epub ahead of print. PMID: 41064861.
https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.125.25511
This study, a secondary analysis of the SPRINT trial, looked at the association between systolic blood pressure time in target range (TTR) and acute kidney injury (AKI) rates in both the intensive and standard groups. As discussed previously, it was shown in the SPRINT trial that more intensive blood pressure control was associated with higher rates of acute kidney injury. Intensive as needed blood pressure treatment in the hospital has also been shown in multiple studies to be associated with higher AKI rates among many other adverse outcomes. Thus, it is an interesting question as to whether patients with tighter blood pressure control within their assigned group would have lower rates of AKI.
In this analysis, patients with more time in the target range did in fact have lower rates of AKI, regardless of group assignment. This led to the conclusion that more blood pressure control was associated with lower rates of AKI. However, the study never showed whether time NOT in the target range was due to elevated pressures, as is inferred, or due to the episodes of hypotension, possibly due to excessive control – an important question given that hypotension is a known cause of AKI.
Without knowing whether the aberrant blood pressures are high or low, we cannot conclude anything about optimal control from this study.
Dr. Confounder 
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