Effects of intensive blood pressure control on cardiovascular outcomes in patients with diabetes: A systematic review and meta-analysis.

Abstract

Hypertension frequently coexists with diabetes, affecting over two-thirds of diabetic patients and significantly increasing cardiovascular (CV) risk. While blood pressure (BP) reduction offers substantial benefits in this population, the optimal systolic blood pressure (SBP) target remains controversial. This meta-analysis evaluates the effects of intensive SBP lowering (<130 mmHg) versus standard therapy (<150 mmHg) on key CV outcomes in hypertensive patients with diabetes. This systematic review and meta-analysis adhered to PRISMA guidelines and included randomized controlled trials (RCTs) assessing SBP targets in diabetic patients. Electronic databases were searched through December 2024. Hazard ratios (HRs) for all-cause mortality, CV death, heart failure (HF), stroke, major adverse cardiovascular events (MACE), and major coronary heart disease events were pooled using a random-effects model. Risk of bias was evaluated using the Cochrane Risk of Bias Tool. Four RCTs involving 21,169 patients were included. Intensive SBP control significantly reduced stroke (HR: 0.71; p = 0.01), HF (HR: 0.69; p = 0.02), CV death (HR: 0.76; p = 0.04), and MACE (HR: 0.82; p < 0.0001) but showed no significant impact on all-cause mortality (HR: 0.90; p = 0.24) or major coronary heart disease events (HR: 0.93; p = 0.16). Heterogeneity was minimal across outcomes. Intensive BP control reduces stroke, HF, CV death, and MACE in hypertensive diabetic patients, highlighting its role in CV risk management. Future research should explore subgroup effects.