BACKGROUND AND AIMS: Hypertension is the predominant modifiable cardiovascular risk factor. This cohort study assessed the association of risk with the percentage of time that the ambulatory blood pressure (ABP) is within the target range (PTTR) proposed by the 2024 European Society of Cardiology (ESC) guidelines for blood pressure (BP) management. METHODS: In a person-level meta-analysis of 14 230 individuals enrolled in 14 population cohorts, systolic and diastolic ABPs were combined to assess 24-h, daytime, and nighttime PTTR with thresholds for non-elevated ABP set at <115/65, <120/70, and <110/60 mmHg, respectively. RESULTS: Median 24-h PTTR was 18% (interquartile range 5-33) corresponding to 4.3 h (1.2-7.9). Over 10.9 years (median), deaths (N = 3117) and cardiovascular endpoints (N = 2265) decreased across increasing 24-h PTTR quartiles from 21.3 to 16.1 and from 20.3 to 11.3 events per 1000 person-years. The standardized multivariable-adjusted hazard ratios for 24-h PTTR were 0.57 (95% confidence interval 0.46-0.71) for mortality and 0.30 (0.23-0.39) for cardiovascular endpoints. Analyses of daytime and nighttime ABP, cardiovascular mortality, coronary endpoints and stroke, and subgroups produced confirmatory results. The 2024 ESC non-elevated 24-h PTTR, compared with the 2018 ESC/European Society of Hypertension non-hypertensive 24-h PTTR, shortened the interval required to reduce relative risk for adverse outcomes from 60% to 18% (14.4-4.3 h). Office BP, compared with 24-h PTTR, misclassified most participants with regard to BP control. CONCLUSIONS: Longer time that ABP is within the 2024 ESC target range is associated with reduced adverse outcomes; PTTR derived from ABP refines risk prediction and compared with office BP avoids misclassification of individuals with regard to BP control.

Asociación Española Montevideo Uruguay

Biomedical Research Group Faculty of Medicine University of Leuven Herestraat 49 BE 3000 Leuven Belgium

Center for Environmental Sciences Hasselt University Diepenbeek Belgium

Center for Health Capital Region of Denmark Copenhagen Denmark

Centro de Nefrología Departamento de Fisiopatología Hospital de Clínicas Universidad de la República Montevideo Uruguay

Conway Institute of Biomolecular and Biomedical Research University College Dublin Dublin Ireland

Department of Cardiology Shanghai General Hospital Shanghai Jiao Tong University School of Medicine Shanghai China

Department of Cardiovascular Medicine Shanghai Institute of Hypertension Shanghai Key Laboratory of Hypertension National Research Centre for Translational Medicine State Key Laboratory of Medical Genomics Ruijin Hospital Shanghai Jiao Tong University School of Medicine Ruijin Er Road 197 200025 Shanghai China

Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Department of Hygiene and Public Health Teikyo University School of Medicine Tokyo Japan

Department of Internal Medicine 2 University Hospital Charles University Medical School Pilsen Czechia

Department of Medicine University of Padua Padua Italy

Department of Preventive Medicine and Public Health School of Medicine Universidad Autónoma de Madrid CIBERESP Madrid Spain

Institute of Internal and Preventive Medicine Branch of the Institute of Cytology and Genetics Siberian Branch of the Russian Academy of Sciences Novosibirsk Russian Federation

Institute of Neuroscience Neuro and Behavioral Health Integrated Service Unit University of Texas Rio Grande Valley Harlingen TX USA

Laboratory of Neurosciences Faculty of Medicine University of Zulia Zulia Venezuela

Non Profit Research Association Alliance for the Promotion of Preventive Medicine Leopoldstraat 59 BE 2800 Mechelen Belgium

Research Unit Environment and Health KU Leuven Department of Public Health and Primary Care University of Leuven Leuven Belgium

Section of Geriatrics Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden

South Texas Alzheimer's Disease Research Center San Antonio Harlingen TX USA

The 1st Department of Cardiology Interventional Electrocardiology and Hypertension Jagiellonian University Medical College Kraków Poland

The Steno Diabetes Center Copenhagen Gentofte Denmark

Tohoku Institute for Management of Blood Pressure Sendai Japan

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doi: 10.1093/eurheartj/ehaf292 PubMed

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