Intensive control of systolic blood pressure significantly reduces the risk of major adverse cardiovascular events but increases the risk of chronic kidney disease.
Meta-Analysis (n=60,629)
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?
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.
Effect estimate: RR 0.82 (95% CI 0.78 to 0.87)
p-value: p=<0.001
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.
Zhang et al. (Thu,) conducted a meta-analysis in Cardiovascular disease and chronic kidney disease (n=60,629). Intensive systolic blood pressure control (<120 mm Hg or <130 mm Hg) vs. Usual systolic blood pressure targets (<130-150 mm Hg) was evaluated on Major adverse cardiovascular events (RR 0.82, 95% CI 0.78 to 0.87, p=<0.001). Intensive control of systolic blood pressure significantly reduces the risk of major adverse cardiovascular events but increases the risk of chronic kidney disease.