Abstract:
Introduction: Optimal Blood Pressure (BP) targets in type 2 Diabetes Mellitus (T2DM) remain uncertain. This study aimed to update the evidence on intensive versus standard BP control in T2DM by incorporating recent large-scale trial BPROAD and reassessing cardiovascular and microvascular outcomes across diverse trials.
Methods: This meta-analysis included eight randomized controlled trials (ABCD, Mehler 2003, ABCD-2V, SANDS, INVEST, ACCORD-BP, J-DOIT3, and BPROAD), comprising a total of 25,686 participants. Intensive arms consistently achieved ~120/70 mmHg regardless of specific trial targets. Follow-up ranged 1.9–8.5 years. The primary end-point was a composite of fatal/non-fatal cardiovascular events; secondary endpoints were diabetic retinopathy, neuropathy and Urine Albumin Excretion (UAE). Pooled Odds Ratios (ORs) with 95 % Confidence Intervals (CIs) were calculated with a random-effects model; heterogeneity was expressed as I².
Results: Compared to standard BP control, intensive BP lowering reduced composite cardiovascular events (OR 0.88, 95% CI 0.79–0.97; I²=17 %). Retinopathy likewise fell (OR 0.84, 95% CI 0.71–0.98; I²=0%). UAE risk declined (OR 0.82, 95% CI 0.71–0.94; I=62 %). The analysis showed an OR of 1.48 (95% CI 1.05–2.10; P = 0.03; I²= 0%) for neuropathy, but the small sample size and wide confidence interval limit confidence in this result.
Conclusion: Lowering BP to approximately 120/70 mmHg, representing a more stringent target than standard control (~135/80 mmHg) is associated with modest reductions in cardiovascular events and improvements in microvascular outcomes including retinopathy and albuminuria in type 2 diabetes. While these benefits are modest and neuropathy data remain limited, the findings support consideration of lower BP targets in this population, applied thoughtfully and tailored to individual risk and tolerability.
