Intensive and Standard Blood Pressure Targets in Patients With Type 2 Diabetes Mellitus: Systematic Review and Meta-analysis
Abstract
BACKGROUND Treatment of hypertension in patients with diabetes mellitus (DM) has been shown to improve cardiovascular outcomes; however, the value of intensive blood pressure (BP) targets remains uncertain. We sought to determine the effectiveness and safety of treating BP to intensive targets (upper limit of 130 mm Hg systolic and 80 mm Hg diastolic) compared with standard targets (upper limit of 140-160 mm Hg systolic and 85-100 mm Hg diastolic) in patients with type 2 DM. METHODS Using electronic databases, bibliographies, and clinical trial registries, we conducted a systematic review and meta-analysis to identify randomized trials enrolling adults diagnosed as having type 2 DM and comparing prespecified BP targets. Data on study characteristics, risk for bias, and outcomes were collected. Random-effects models were used to pool relative risks and risk differences for mortality, myocardial infarction, and stroke. RESULTS The use of intensive BP targets was not associated with a significant decrease in the risk for mortality (relative risk difference, 0.76; 95% CI, 0.55-1.05) or myocardial infarction (relative risk difference, 0.93; 95% CI, 0.80-1.08) but was associated with a decrease in the risk for stroke (relative risk, 0.65; 95% CI, 0.48-0.86). The pooled analysis of risk differences associated with the use of intensive BP targets demonstrated a small absolute decrease in the risk for stroke (absolute risk difference, -0.01; 95% CI, -0.02 to -0.00) but no statistically significant difference in the risk for mortality or myocardial infarction. CONCLUSION Although the use of intensive compared with standard BP targets in patients with type 2 DM is associated with a small reduction in the risk for stroke, evidence does not show that intensive targets reduce the risk for mortality or myocardial infarction.
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CVD risk decreases significantly because of a decrease of LDL-C level from 94 mg/dL to 54 mg/dL when statins and ezetimibe are used for treatment in patients with ACS.
“Furthermore, CVD risk decreases significantly because of a decrease of LDL-C level from 94 mg/dL to 54 mg/dL when statins and ezetimibe are used for treatment in patients with ACS.”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [808]
The effects of statins and ezetimibe on CVD risk were evident especially in patients with DM.
“The effects were evident especially in patients with DM808).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [808]
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- Authors
- McBrien, K., Rabi, D. M., Campbell, N., Barnieh, L., Clement, F., Hemmelgarn, B. R., Tonelli, M., Leiter, L. A., Klarenbach, S. W., & Manns, B. J.
- Corresponding author
- Manns, Braden J.
- ORCID
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2012-09-24
- Volume
- 172
- Issue
- 17
- Pages
- 1296
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2025545342
- Cited by
- 129
- References
- 30
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 5 · 2022: 4 · 2021: 3 · 2020: 10 · 2019: 7 · 2018: 14 · 2017: 15 · 2016: 18 · 2015: 12 · 2014: 12 · 2013: 14 · 2012: 9
- FWCI
- 9.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, hypertension, blood pressure targets, intensive blood pressure control, antihypertensive therapy, stroke risk, myocardial infarction, mortality, cardiovascular outcomes
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