Medicina clinica · 2026
Intensive versus standard blood pressure control in patients with and without type 2 diabetes: A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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de Oliveira Ramos João Victor, Andrade Fernandes João Vitor, Camilo Madruga de Oliveira Lima Flávia Maria, Toscano Matias José Lucas, de Lima Beltrão Fabyan Esberard, Tavares de Melo Marcelo Dantas
Аннотация
BACKGROUND: The optimal intensity of blood pressure (BP) control in patients with and without type 2 diabetes mellitus (T2D) remains unclear.
OBJECTIVES: We performed a systematic review and meta-analysis of randomized controlled trials comparing intensive versus standard BP control, stratified by T2D status.
METHODS: Primary outcomes were all-cause mortality and serious adverse events (SAEs); secondary outcomes included death from cardiovascular causes and occurrence of myocardial infarction (MI) and stroke. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using DerSimonian-Laird random-effects models. Heterogeneity was assessed with the I2 statistic, and leave-one-out sensitivity analyses were conducted for all outcomes.
RESULTS: Six trials comprising 41,210 participants were included. Intensive BP control significantly reduced death from cardiovascular causes (OR 0.72; 95% CI 0.56-0.93), incidence of MI (OR 0.85; 95% CI 0.74-0.97), and stroke (OR 0.78; 95% CI 0.68-0.89). The reduction in all-cause mortality was significant in patients without T2D (OR 0.73; 95% CI 0.59-0.90), but not in those with T2D (OR 0.99; 95% CI 0.85-1.14). Intensive control was associated with a non-significant increase in SAEs overall (OR 1.15; 95% CI 0.90-1.46), with higher estimates in patients with T2D.
CONCLUSIONS: Intensive BP control reduces cardiovascular events and mortality in non-diabetic patients. In those with T2D, benefits are attenuated and may be counterbalanced by safety concerns. BP targets should be individualized based on diabetes status and clinical context.
OBJECTIVES: We performed a systematic review and meta-analysis of randomized controlled trials comparing intensive versus standard BP control, stratified by T2D status.
METHODS: Primary outcomes were all-cause mortality and serious adverse events (SAEs); secondary outcomes included death from cardiovascular causes and occurrence of myocardial infarction (MI) and stroke. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using DerSimonian-Laird random-effects models. Heterogeneity was assessed with the I2 statistic, and leave-one-out sensitivity analyses were conducted for all outcomes.
RESULTS: Six trials comprising 41,210 participants were included. Intensive BP control significantly reduced death from cardiovascular causes (OR 0.72; 95% CI 0.56-0.93), incidence of MI (OR 0.85; 95% CI 0.74-0.97), and stroke (OR 0.78; 95% CI 0.68-0.89). The reduction in all-cause mortality was significant in patients without T2D (OR 0.73; 95% CI 0.59-0.90), but not in those with T2D (OR 0.99; 95% CI 0.85-1.14). Intensive control was associated with a non-significant increase in SAEs overall (OR 1.15; 95% CI 0.90-1.46), with higher estimates in patients with T2D.
CONCLUSIONS: Intensive BP control reduces cardiovascular events and mortality in non-diabetic patients. In those with T2D, benefits are attenuated and may be counterbalanced by safety concerns. BP targets should be individualized based on diabetes status and clinical context.