Intensive Blood Pressure Control in Type 2 Diabetes: A Systematic Review and Meta-Analysis of Cardiovascular and Microvascular Outcomes

BACKGROUND The optimal blood pressure (BP) target for adults with type 2 diabetes (T2DM) remains a topic of debate. This systematic review and meta-analysis aimed to investigate the efficacy of intensive BP control strategies compared to standard or less intensive approaches in adults with T2DM. METHODS We comprehensively searched databases for studies comparing intensive vs. less intensive BP targets in individuals with T2DM. In this study, the group with the most intensive target was compared to the group with the least intensive target. Also, studies were analyzed based on current guideline recommendations. Outcomes of interest included major adverse cardiovascular events (MACE), all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stroke, heart failure, retinopathy, neuropathy, nephropathy, and end-stage renal disease. Risk ratios with 95% confidence intervals were calculated. RESULTS The meta-analysis included 21 studies (16 RCTs) with 290,907 participants (mean age 61.84 years, 55.03% male). Guideline-based analyses showed comparable clinical outcomes between groups with no significant differences. However, the most intensive targets vs. the least intensive targets revealed that the intensive BP control group experienced a significantly lower risk of MACE (RR = 0.75, 0.58; 0.98), nonfatal MI (RR = 0.61, 0.41; 0.91), nonfatal stroke (RR = 0.60, 0.39; 0.92), and total stroke (RR = 0.61, 0.39; 0.95). Other outcomes were similar between groups. Subgroup analysis of RCTs mirrored the overall findings. CONCLUSIONS In adults with T2DM, intensive BP control reduces the risk of cardiovascular events, such as MACE, stroke, and MI. Additionally, it demonstrates comparable diabetes-related complications to less intensive or standard controls.