Impact of intensive versus standard blood pressure control on cardiovascular events in hypertensive patients: a meta-analysis of randomized controlled trials

Elevated blood pressure (BP) is the most significant modifiable risk factor for cardiovascular morbidity and mortality. However, the optimal systolic BP target in hypertensive patients remains unclear. We conducted a meta-analysis of randomized controlled trials (RCTs) comparing intensive (≤120 mmHg) versus standard (≤140 mmHg) systolic BP control. A systematic search of three databases identified six RCTs including 39 811 patients (mean age 64.8 years). Intensive BP control significantly reduced the risk of stroke [risk ratio (RR) 0.81; 95% confidence interval (CI) 0.74-0.90], myocardial infarction (RR 0.83; 95% CI 0.73-0.95), cardiovascular death (RR 0.73; 95% CI 0.58-0.91), and all-cause mortality (RR 0.87; 95% CI 0.76-0.99). No significant differences were observed in bradycardia (RR 1.12; 95% CI 0.70-1.77) or symptomatic hypotension (RR 2.25; 95% CI 0.61-8.24), though syncope occurred more frequently with intensive control (RR 1.54; 95% CI 1.23-1.92). Intensive systolic BP control may offer substantial cardiovascular benefits with minimal adverse effects and should be considered in clinical practice.