Key result
Intensive SBP control cuts major cardiovascular events ~20% compared to standard control.
Why the study?
The comparative efficacy and safety of intensive systolic blood pressure control versus standard control in reducing cardiovascular risk remain to be systematically evaluated.
Does intensive systolic blood pressure control (target <120 mmHg) reduce major adverse cardiovascular events compared to standard control (<140 mmHg) in adults with hypertension?
Meta-Analysis (n=39,433)
Open-label
Random allocation (in included trials)
Yes
Does intensive systolic blood pressure control (target <120 mmHg) reduce major adverse cardiovascular events compared to standard control (<140 mmHg) in adults with hypertension?
Intensive systolic blood pressure targets (<120 mmHg) provide meaningful reductions in major adverse cardiovascular events compared to <140 mmHg targets, though at the cost of higher rates of hypotension and syncope.
Answers are grounded in this paper and cite their sources.
Intensive SBP <120 mmHg targets reduce MACE with safety trade-offs; confirms and extends prior RCT benefits in this 39,433-patient meta-analysis.
Objective The study aimed to compare the efficacy and safety of intensive systolic blood pressure (SBP) control (target SBP < 120 mmHg) vs. standard blood pressure control (target SBP < 140 mmHg) in reducing cardiovascular risk. Methods We conducted a systematic search of the Cochrane Library, Embase, and PubMed databases, covering the period from the inception of each database to February 11, 2025, to identify randomized controlled trials comparing these two blood pressure control targets. Efficacy outcomes included major adverse cardiovascular events, heart failure, stroke, myocardial infarction, cardiovascular mortality, and all-cause mortality. Safety outcomes included hypotension, syncope, falls, and renal dysfunction. Results Five randomized controlled trials involving 39,433 patients were included. Compared to standard blood pressure control, intensive blood pressure control was associated with a significant reduction in the risk of major adverse cardiovascular events (RR, 0.80; 95% CI, 0.75–0.86; P < 0.001), heart failure (RR, 0.74; 95% CI, 0.62–0.90; P = 0.002), stroke (RR, 0.81; 95% CI, 0.73–0.90; P < 0.001), cardiovascular mortality (RR, 0.73; 95% CI, 0.56–0.94; P = 0.01), and all-cause mortality (RR, 0.86; 95% CI, 0.75–0.99; P = 0.03). Intensive blood pressure control was associated with a borderline statistically significant reduction in the risk of myocardial infarction (RR, 0.87, 95% CI 0.76–1.00; P = 0.04). Intensive blood pressure control increased the risks of hypotension (RR, 3.63; 95% CI, 1.41–9.35; P = 0.008) and syncope (RR, 1.50; 95% CI, 1.22–1.85; P < 0.001). Conclusion Based on currently available evidence, intensive blood pressure control may reduce the risk of cardiovascular events and mortality compared to standard blood pressure control, but it may increase the risk of hypotension and syncope.
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Yang et al. (2026) conducted a meta-analysis in Hypertension at high cardiovascular risk (n=39,433). Intensive systolic blood pressure control vs. Standard blood pressure control (target SBP < 140 mmHg) was evaluated on Major adverse cardiovascular events (composite of heart failure, myocardial infarction, stroke, and cardiovascular mortality) (RR 0.80, 95% CI 0.75-0.86, p=<0.001). Intensive systolic blood pressure control (<120 mmHg) reduced the risk of major adverse cardiovascular events by 20% compared to standard control (<140 mmHg).
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