What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Cardiovascular disease and chronic kidney disease (n=60629). Intervention: Intensive systolic blood pressure control (<120 mm Hg or <130 mm Hg) vs. Usual systolic blood pressure targets (<130-150 mm Hg). Primary outcome: Major adverse cardiovascular events (RR 0.82, 95% CI 0.78 to 0.87, p=<0.001).

February 2, 2026Open Access

Outcome specific optimal systolic blood pressure targets in high risk patients, balancing cardiovascular benefits, renal risks, and cancer prevention: meta-analysis of randomised controlled trials

Q: What are the key findings of this study?

Intensive control of systolic blood pressure significantly reduces the risk of major adverse cardiovascular events but increases the risk of chronic kidney disease.

Q: What does this research mean for the field?

Intensive control of systolic blood pressure significantly reduces the risk of major adverse cardiovascular events but increases the risk of chronic kidney disease. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Q: What question did this study set out to answer?

To compare the efficacy and safety of different intensive systolic blood pressure targets against usual care in high-risk patients.

Key Result

Intensive control of systolic blood pressure significantly reduces the risk of major adverse cardiovascular events but increases the risk of chronic kidney disease.

Key Points

To compare the efficacy and safety of different intensive systolic blood pressure targets against usual care in high-risk patients.
Conducted a meta-analysis of randomized controlled trials
Included trials comparing systolic blood pressure targets of <120 mm Hg and <130 mm Hg with usual care
Analyzed outcomes related to cardiovascular disease and kidney function
Intensive control reduced major cardiovascular events by 18% (relative risk 0.82)
Targets of <120 mm Hg and <130 mm Hg gave similar cardiovascular protection
Intensive control increased the risk of chronic kidney disease (relative risk 1.40)
A target of <120 mm Hg reduced albuminuria but raised risks of bradycardia and hypotension

Study Design

Type

Meta-Analysis (n=60,629)

Structured PICO

Does intensive systolic blood pressure control (<120 or <130 mm Hg) reduce major adverse cardiovascular events and chronic kidney disease progression in high-risk patients?

Population

18 RCTs pooling 60,629 high-risk participants (including those with previous stroke, chronic kidney disease, or diabetes), mean age 36.5-80.5 years, 23.0-80.7% women. Baseline systolic blood pressure ranged from 123.4 to 163.3 mm Hg.

Intervention

Intensive systolic blood pressure targets (<120 mm Hg or <130 mm Hg) achieved through intensification of antihypertensive drug treatments.

Comparator

Usual systolic blood pressure targets (<130-150 mm Hg or <140 mm Hg) achieved through standard antihypertensive drug treatments.

Outcome

Incident major adverse cardiovascular events (composite of stroke, myocardial infarction, heart failure, and death from cardiovascular disease) and composite chronic kidney disease outcomes (end stage kidney disease, eGFR <15 mL/min/1.73 m2, or >50% reduction in eGFR from baseline in patients with CKD; or eGFR <60 with >30% reduction in non-CKD).composite

A systolic blood pressure target of <130 mm Hg offers comparable cardiovascular protection to a <120 mm Hg target but with a more favorable renal safety profile, supporting a personalized approach to blood pressure management.

Main Result

Effect estimate: RR 0.82 (95% CI 0.78 to 0.87)

p-value: p=<0.001

Limitations

Study included various trials with diverse populations, which may introduce variability in treatment effect.
Short trial durations may limit the ability to detect end-stage kidney disease events.

Abstract

Objective To directly compare the efficacy and safety of different intensive systolic blood pressure targets (<120 or <130 mm Hg) versus usual care on cardiovascular and renal outcomes. Design Meta-analysis of randomised controlled trials. Data sources Web of Science and Medline, from inception to 20 May 2025. Eligibility criteria for selecting studies Randomised controlled trials comparing intensive versus usual systolic blood pressure targets. Studies reported cardiovascular disease or kidney outcomes, or both. Results The study included 18 randomised controlled trials of 60 629 participants. Intensive control of systolic blood pressure significantly reduced the risk of major adverse cardiovascular events (relative risk 0.82, 95% confidence interval (CI) 0.78 to 0.87, P<0.001), including myocardial infarction, stroke, heart failure, and death from cardiovascular disease. Systolic blood pressure targets of <120 mm Hg and <130 mm Hg provided comparable cardiovascular protection. Intensive control of systolic blood pressure increased the risk of the composite chronic kidney disease outcome (relative risk 1.40, 95% CI 1.01 to 1.94, P=0.046), but with a likely higher risk for the target of <120 mm Hg. A systolic blood pressure target of <120 mm Hg also reduced the risk of albuminuria, but increased the risk of bradycardia and hypotension. Conclusions Intensive control of systolic blood pressure provided substantial cardiovascular benefits but increased the risk of renal adverse events. A systolic blood pressure target of <130 mm Hg had a similar degree of cardiovascular protection as <120 mm Hg with a more favourable renal safety profile, supporting a personalised risk based approach to treatment intensification. Trial registration PROSPERO CRD42025629962.

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