American Journal of Preventive Cardiology · Jun 8, 2026

Time in target systolic blood pressure range and cardiometabolic disease-free life expectancy in hypertensive elderly

By Li L, Zhang J, Yu H et al.

BACKGROUND: Although sustained blood pressure control is known to reduce cardiovascular and renal events, its long-term impact on overall life expectancy and the proportion of life lived free from cardiometabolic disease (CMD) remains insufficiently quantified. AIMS: To examine the associations between systolic blood pressure time in target range (SBP-TTR) and total life expectancy, CMD-free life expectancy, and life expectancy lived with CMD among adults with hypertension. METHODS: This prospective cohort study included 18,503 adults aged ≥45 years with hypertension from the Kailuan Study (China), followed from 2006 to 2022. SBP-TTR (120-140 mmHg) was assessed over a 6-year exposure period. Multistate life table models were applied to estimate total, CMD-free, and CMD-lived life expectancy across SBP-TTR categories. RESULTS: During a mean follow-up of 11.94 years, 7,393 incident CMD events were identified, including 1,443 deaths after CMD onset. Estimated CMD-free life expectancy increased progressively across SBP-TTR categories, from 38.77 years (95% CI: 38.50-39.05) in the low group to 40.29 years (95% CI: 40.19-40.23) in the high group. Compared with low SBP-TTR, high SBP-TTR was associated with 1.51 additional years of total life expectancy and 6.18 additional CMD-free years, alongside a 4.67-year reduction in CMD-lived life expectancy. Early blood pressure control conferred greater benefits than later control. CONCLUSION: Higher SBP-TTR is associated with longer life expectancy and, importantly, a greater proportion of life lived free from CMD, supporting SBP-TTR as a clinically meaningful metric for long-term hypertension management.

doi.org/10.1016/j.ajpc.2026.101430Open accessPubMed 42291063Populations