What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Type 2 diabetes (n=34260). Intervention: Intensive blood pressure control vs. Conventional blood pressure control. Primary outcome: Major adverse cardiovascular events (MACE) (RR 0.80, 95% CI 0.73-0.89, p=<0.001).

What question did this study set out to answer?

This meta-analysis aims to evaluate the effects of intensive versus conventional blood pressure control on major adverse cardiovascular events in patients with type 2 diabetes.

June 24, 2026Open Access

Intensive blood pressure control in type 2 diabetes: a meta-analysis of randomized controlled trials

Q: What are the key findings of this study?

Intensive blood pressure control significantly reduced the risk of major adverse cardiovascular events (RR 0.80) compared with conventional control in patients with type 2 diabetes.

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

This meta-analysis aims to evaluate the effects of intensive versus conventional blood pressure control on major adverse cardiovascular events in patients with type 2 diabetes.

Key Result

Intensive blood pressure control significantly reduced the risk of major adverse cardiovascular events (RR 0.80) compared with conventional control in patients with type 2 diabetes.

Key Points

This meta-analysis aims to evaluate the effects of intensive versus conventional blood pressure control on major adverse cardiovascular events in patients with type 2 diabetes.
Conducted a meta-analysis of randomized controlled trials comparing intensive and conventional blood pressure management.
Incorporated data from nine trials with 34,260 participants.
Utilized a random-effects model and performed subgroup analyses based on blood pressure targets.
Intensive blood pressure control reduced the risk of major adverse cardiovascular events by 20% compared to conventional control (RR, 0.80; 95% CI, 0.73–0.89; P < 0.001).
Intensive treatment significantly lowered the risk of stroke (RR, 0.73; 95% CI, 0.60–0.87; P = 0.008).
While intensive treatment increased the risk of hypotension (RR, 4.61; 95% CI, 1.01–20.99; P = 0.05), it did not significantly affect other adverse events.

Study Design

Type

Meta-Analysis (n=34,260)

Structured PICO

Does intensive blood pressure control reduce MACE in patients with type 2 diabetes?

Population

9 trials comprising 34,260 participants with type 2 diabetes (T2D)

Intervention

Intensive blood pressure control

Comparator

Conventional blood pressure control

Outcome

Major adverse cardiovascular events (MACE)composite

Intensive blood pressure control significantly reduces the risk of MACE, driven primarily by a reduction in stroke, in patients with type 2 diabetes, though it carries a borderline increased risk of hypotension.

Main Result

Effect estimate: RR 0.80 (95% CI 0.73-0.89)

Absolute Event Rate: 7.9% vs 9.7%

p-value: p=<0.001

Limitations

Three of the included studies were based on post hoc subgroup analyses of broader hypertension trials.
Recent studies generally use a broader definition of MACE than earlier studies.
Four included studies were conducted in China and accounted for approximately 56.2% of the overall weight, which may limit generalizability.
All included trials employed an open-label design, which may lead to higher reported rates of adverse events.
Some studies did not clearly specify the method of blood pressure measurement.

Abstract

Background Although guidelines recommend lower blood pressure targets for patients with type 2 diabetes (T2D), evidence from randomized controlled trials (RCTs) remains inconsistent regarding the balance between reducing major adverse cardiovascular events (MACE) and the risk of adverse events. Methods This meta-analysis included RCTs comparing intensive versus conventional blood pressure control in patients with T2D. The primary outcome was MACE, and secondary outcomes included adverse events. Data were synthesized using a random-effects model. Subgroup analyses were conducted to assess the influence of different blood pressure targets and concomitant intensive glucose or lipid management. Results Nine trials comprising 34,260 participants with T2D were included. Intensive blood pressure control was associated with a significantly lower risk of MACE compared with conventional control 7.9% vs 9.7%; risk ratio (RR), 0.80; 95% CI, 0.73–0.89; P 0.001. Among individual MACE components, intensive treatment significantly lowered the risk of stroke (RR, 0.73; 95% CI, 0.60–0.87; P = 0.008), whereas no significant differences were observed for heart failure, myocardial infarction and cardiovascular death risk. Subgroup analyses suggested a potentially treatment benefit in trials aiming for a systolic blood pressure (SBP) target of 130 mm Hg and incorporating an explicit diastolic blood pressure (DBP) target Concomitant intensive glucose or lipid control did not significantly modify the treatment effect. Regarding safety, intensive treatment was associated with a borderline increased risk of hypotension (RR, 4.61; 95% CI, 1.01–20.99; P = 0.05) but not with other adverse events. Conclusions Intensive blood pressure control significantly reduces the risk of MACE in patients with T2D. Strategies incorporating explicit DBP targets may offer substantial benefits. However, it should be paid attention to monitoring and preventing adverse events. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420251266814.

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