Effects of intensive systolic blood pressure control in diabetic patients: a systematic review and meta-analysis comparing 120 mmHg vs. 140 mmHg targets

Abstract Background The optimal systolic blood pressure (SBP) target for diabetic patients remains a subject of debate. While intensive SBP control (120 mmHg) has demonstrated cardiovascular benefits, concerns about potential adverse effects persist. This systematic review and meta-analysis aim to evaluate whether intensive SBP reduction leads to better outcomes than the standard target (140 mmHg). Purpose We aim to conduct a systematic review and meta-analysis comparing the benefits and harms of intensive versus standard SBP targets in diabetic patients. Methods We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) that compared intensive and standard SBP targets in patients with diabetes. Statistical analysis was carried out utilizing R version 4.4.2. Heterogeneity was assessed with I² statistics; p-values inferior to 0.05 and I²25% were considered significant heterogeneity. Results Three RCTs were included, involving a total of 9,072 participants. The incidence of all types of stroke was significantly lower in the intensive SBP control group compared to the standard group (HR 0.76; 95% CI: 0.66-0.87; p 0.001; Figure 1). However, there was no significant reduction in all-cause mortality (HR 1.00; 95% CI: 0.86-1.17; p = 0.978), cardiovascular death (HR 0.89; 95% CI: 0.64-1.23; p = 0.483) or myocardial infarction (RR 0.86; 95% CI: 0.71-1.03; p = 0.106). A significant increase in the incidence of hypotension was observed in the intensive SBP group (HR 11.81; 95% CI: 2.78-50.22; p 0.001; Figure 2). The incidence of syncope (HR 1.48; 95% CI: 0.63-3.49; p = 0.370) and renal failure (HR 0.28; 95% CI: 0.28-9.45; p = 0.584) were similar between groups. Conclusion Our systematic review and meta-analysis suggest that intensive SBP control reduces stroke risk but does not improve mortality or myocardial infarction and increases the risk of hypotension. An individual careful risk-benefit assessment is essential.