Time in target range of systolic blood pressure and eGFR slope in patients with type 2 diabetes

Time in target range (TTR) of systolic blood pressure is a novel measure to assess the effect of blood pressure control. However, few studies have explored the renoprotective value of systolic TTR in patients with type 2 diabetes (T2D). We analyzed the database of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) blood pressure (BP) trial. The systolic target range was established as 120-140 and 110-130 mm Hg for the standard group and intensive therapy, respectively. Multivariate linear regression was conducted to evaluate the relationship between systolic blood pressure and estimated glomerular filtration rate (eGFR) slope. After adjusting for covariates, systolic TTR showed a significant and positive association with two measures of eGFR slope (n = 4327, P < 0.04). The correlation of systolic TTR and eGFR slope was notably stronger in CKD patients (n = 1635) compared to those without (P for interaction < 0.05). When analyzing systolic TTR as a categorical variable, participants with CKD in the highest systolic TTR quantile had a significantly positive relationship with eGFR slope (P <= 0.0001). These findings were consistently observed across further subgroup analyses. Among T2D patients, systolic TTR exhibited a significant and positive relation to eGFR slope, with a stronger relationship noted in individuals diagnosed with CKD. This underscores the critical role of stable blood pressure control for renoprotection in patients with T2D, particularly in those with CKD. (Trial Registration: ClinicalTrials.gov number: NCT00000620).