Intensive versus routine blood pressure control in patients with type 2 diabetes: A Meta-analysis and Trial sequential analysis

Optimal blood pressure (BP) targets for type 2 diabetes remain controversial. Although intensive BP control reduces cardiovascular risk in the general population, its net benefit in diabetes is uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials comparing intensive BP control (target < 130/80 mmHg or achieved systolic <130 mmHg) with routine control in adults with type 2 diabetes. Databases (PubMed, Embase, Cochrane CENTRAL) were searched through November 2024; two reviewers independently extracted data and assessed bias. Random-effects meta-analysis estimated pooled relative risks (RRs) with 95% confidence intervals (CIs), and trial sequential analysis (TSA) assessed robustness. Eleven trials comprising 24,308 participants met inclusion criteria. Intensive BP control reduced stroke (RR: 0.64; 95% CI: 0.51-0.81) and major cardiovascular events (RR: 0.86; 95% CI: 0.72-1.03) with no significant differences in mortality or heart-failure hospitalization. TSA confirmed firm evidence for stroke reduction, mortality and heart failure results remained inconclusive.