Maintaining systolic blood pressure (SBP) ≤120 mmHg in type 2 diabetes increased the risk of all-cause mortality by 15% (RR 1.15) and was associated with more harms than benefits.
Does maintaining SBP below 140, 130, or 120 mmHg reduce the 10-year risk of CVD and all-cause mortality in Chinese patients with type 2 diabetes?
In Chinese patients with type 2 diabetes, targeting an SBP ≤120 mmHg reduces CVD risk but may increase all-cause mortality, suggesting it is not an optimal target.
Abstract Aims The effective target for systolic blood pressure (SBP) control in patients with diabetes was inconsistent. We evaluated the emulated effect of maintaining SBP below clinical thresholds on the risk of cardiovascular disease (CVD) and all‐cause mortality. Materials and Methods This study included 4264 patients with type 2 diabetes from the Kailaun study. We implemented the parametric g‐formula to simulate the hypothetical interventions on reducing SBP below 140, 130 and 120 mmHg over time, accounting for time‐varying confounding, reporting risk ratio (RR) and number needed to treat (NNT) for 10‐year risk of CVD and all‐cause mortality. Results Maintaining SBP below 140, 130 and 120 mmHg was associated with an 18%, 24%, and 31% relative risk reduction in the risk of CVD, with the RR (95% confidence interval CI) of 0.82 (0.75–0.88), 0.76 (0.69–0.86), and 0.69 (0.58–0.84), and the NNT of 32, 24, and 19, respectively, compared to no intervention. However, the benefits in reducing the risk of all‐cause mortality did not reach a significant level with maintaining SBP below 140 and 130 mmHg, with the RR (95% CI) of 0.98 (0.93–1.06) and 1.04 (0.95–1.12), respectively. The risk of all‐cause mortality significantly increased 15% with maintaining SBP ≤120 mmHg (RR, 1.15; 95% CI, 1.02–1.32). Subgroup analyses showed that maintaining SBP ≤120 mmHg tended to bring more harms than benefits in patients aged ≥60 years or without antihypertensive agents. Conclusion Among Chinese patients with type 2 diabetes, maintaining SBP ≤120 mmHg may not be an optimal target, in terms of the risk–benefit association of CVD and all‐cause mortality.
Tian et al. (2026) studied this question. Maintaining systolic blood pressure (SBP) ≤120 mmHg in type 2 diabetes increased the risk of all-cause mortality by 15% (RR 1.15) and was associated with more harms than benefits.