Impact of amlodipine-based therapy on blood pressure time in target range in Chinese adults with primary hypertension: a retrospective study

Recently, both international and Chinese guidelines have mentioned for the first time that blood pressure (BP) target range is more reasonable and workable than BP target in clinical practice, and time in target range (TTR) could become a potential evaluation indicator for long-term blood pressure management. Until now, there was no research on the long-term effects of antihypertensive treatment on systolic BP (SBP) TTR. The objective, therefore, is to observe the impact of long-acting calcium channel blockers (CCBs) on BP TTR in Chinese patients with hypertension (HTN). A retrospective observational study was conducted using data from the China Cardiovascular Association Hypertension Centre, including 36,153 adult patients diagnosed with primary HTN and treated with amlodipine-based antihypertensive therapy between 1 January 2018 and 31 December 2022. The primary endpoint was the SBP TTR. Other endpoints included the annual trend of SBP TTR, factors influencing SBP TTR, etc. Results showed an overall SBP TTR was 80.42 ± 21.97%. The SBP TTR at 1, 2 and 3 years of follow-up was 79.49 ± 26.16%, 81.86 ± 25.10% and 82.79 ± 25.77%, respectively, showing a significant difference (<i>p</i> &lt; 0.001). Seven factors were positively correlated with SBP TTR, while three factors were negatively correlated with SBP TTR including heart failure, high baseline SBP level, and high LDL-C level. Long-term and continuous use of amlodipine-based antihypertensive therapy could improve SBP TTR. This finding may relate to the characteristic of amlodipine which is a long-acting drug due to pharmacokinetic properties. Chinese Clinical Trial Registry Identifier: ChiCTR2400090150. What is the context?Hypertension (HTN) is a major health problem worldwide. Physicians usually measure blood pressure (BP) during clinic visits, but this only provides a single snapshot of BP control. Time in target range (TTR) is considered a new approach to evaluate long-term BP management by international and domestic guidelines. TTR reflects the prevailing BP during the follow-up period and the magnitude of BP variability (BPV). In China, amlodipine—a long-acting antihypertensive therapy—is widely used, but its long-term effects on TTR have not well studied. Hypertension (HTN) is a major health problem worldwide. Physicians usually measure blood pressure (BP) during clinic visits, but this only provides a single snapshot of BP control. Time in target range (TTR) is considered a new approach to evaluate long-term BP management by international and domestic guidelines. TTR reflects the prevailing BP during the follow-up period and the magnitude of BP variability (BPV). In China, amlodipine—a long-acting antihypertensive therapy—is widely used, but its long-term effects on TTR have not well studied. What is new?This study analysed more than 3 years of data from 36, 153 Chinese adults with primary HTN who continuous prescribe amlodipine-based antihypertensive therapy.The key findings included:Overall SBP TTR was over 80% and the annual trend of SBP TTR was increasing.Follow-up frequency and target range significantly influence the value of TTR.Figure out seven positive factors and three negative factors which were correlated with SBP TTR. This study analysed more than 3 years of data from 36, 153 Chinese adults with primary HTN who continuous prescribe amlodipine-based antihypertensive therapy. The key findings included: Overall SBP TTR was over 80% and the annual trend of SBP TTR was increasing. Follow-up frequency and target range significantly influence the value of TTR. Figure out seven positive factors and three negative factors which were correlated with SBP TTR. What is the impact?These findings provide strong evidence that continuous long-acting antihypertensive therapy, such as amlodipine, can effectively improve long-term BP management.In clinical practice, reasonable follow-up frequency and target range should be accurately defined based on more evidence.Factors influencing SBP TTR underscore the importance of early detection, timely and standardised treatment, long-term regular follow-up, and improved medication compliance once more. These findings provide strong evidence that continuous long-acting antihypertensive therapy, such as amlodipine, can effectively improve long-term BP management. In clinical practice, reasonable follow-up frequency and target range should be accurately defined based on more evidence. Factors influencing SBP TTR underscore the importance of early detection, timely and standardised treatment, long-term regular follow-up, and improved medication compliance once more.

近年来，国内外指南首次提出，血压（blood pressure，BP）靶范围在临床实践中较单一血压靶目标更为合理且可行，而靶达标时间（time in target range，TTR）有望成为长期血压管理的潜在评估指标。截至目前，尚无研究探讨降压治疗对收缩压（systolic BP，SBP）靶达标时间的长期影响。因此本研究旨在观察长效钙通道阻滞剂（long-acting calcium channel blockers，CCBs）对中国高血压（hypertension，HTN）患者血压靶达标时间的影响。本研究采用中国心血管病协会高血压中心的回顾性观察性研究数据，纳入2018年1月1日至2022年12月31日期间确诊为原发性高血压且接受以氨氯地平为基础的降压治疗的36153名成年患者。主要终点为收缩压靶达标时间，次要终点包括收缩压靶达标时间的年度变化趋势、收缩压靶达标时间的影响因素等。结果显示，整体收缩压靶达标时间为80.42±21.97%。随访1、2、3年时的收缩压靶达标时间分别为79.49±26.16%、81.86±25.10%及82.79±25.77%，组间差异具有统计学意义（P < 0.001）。共7个因素与收缩压靶达标时间呈正相关，3个因素呈负相关，分别为心力衰竭、高基线收缩压水平及高低密度脂蛋白胆固醇（LDL-C）水平。长期持续使用以氨氯地平为基础的降压治疗可改善收缩压靶达标时间，这一发现可能与氨氯地平作为长效药物的药代动力学特性有关。本研究的中国临床试验注册中心（Chinese Clinical Trial Registry）注册号为ChiCTR2400090150。【研究背景】高血压（HTN）是全球范围内的重大公共卫生问题。临床医师通常仅在门诊就诊时测量血压，这仅能提供单次血压控制的快照信息。靶达标时间（TTR）被国内外指南视为评估长期血压管理的新方法，其可反映随访期间的平均血压水平及血压变异性（blood pressure variability，BPV）。在我国，氨氯地平作为长效降压治疗药物被广泛应用，但其对靶达标时间的长期影响尚未得到充分研究。【研究创新点】本研究分析了36153名中国原发性高血压成年患者超过3年的随访数据，这些患者均持续接受以氨氯地平为基础的降压治疗。本研究的核心发现包括：整体收缩压靶达标时间超过80%，且收缩压靶达标时间的年度变化趋势呈上升态势；随访频率及靶范围对靶达标时间的数值具有显著影响；明确了7个与收缩压靶达标时间呈正相关的因素及3个呈负相关的因素。【研究意义】本研究结果为持续使用长效降压治疗（如氨氯地平）可有效改善长期血压管理提供了强有力的证据支持。在临床实践中，应基于更多研究证据精准设定合理的随访频率及靶范围。收缩压靶达标时间的影响因素进一步凸显了早期筛查、及时规范治疗、长期规律随访以及提高服药依从性的重要性。