NYMC Faculty Publications

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

Asma Mousavi, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Shayan Shojaei, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Amir Parsa Abhari, Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Seyed Alireza Mirhosseini, Cardiovascular Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Rasoul Ebrahimi, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Erta Rajabi, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Mashood Ahmad Farooqi, PGY-1 Internal Medicine Central Michigan University, Saginaw, Michigan, USA.
Amirali Azizpour, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Shiva Armani Moghadam, Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Toshiki Kuno, Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Anil Harrison, Internal Medicine, Midwestern University, Glendale, Arizona, USA.
Wilbert Aronow, Cardiology Division, Westchester Medical Center, New York Medical College, Valhalla, New York, USA.
Abdul Waheed, Department of Family Medicine, Dignity Health Medical Group, Gilbert, Arizona, USA.
Rosy Thachil, Elmhurst Hospital Center/Mount Sinai School of Medicine, Elmhurst, New York, USA.
Kaveh Hosseini, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.

Author Type(s)

Faculty

DOI

10.1093/ajh/hpaf140

Journal Title

American Journal of Hypertension

First Page

48

Last Page

62

Document Type

Article

Publication Date

1-1-2026

Department

Medicine

Keywords

MACE, blood pressure, hypertension, meta-analysis, target blood pressure, type 2 diabetes mellitus

Disciplines

Medicine and Health Sciences

Abstract

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.

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