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  • JSH2025 Systematic Review Series: Clinical Questions in the Management of Hypertension
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Intensive blood pressure-lowering treatment to prevent cardiovascular events in patients with diabetes: a systematic review and meta-analysis

Hypertension Research volume 48, pages 2024–2033 (2025)Cite this article

Abstract

The effect of intensive blood pressure (BP) reduction on the prevention of cardiovascular events in patients with diabetes remains unclear. This study evaluated the impact of intensive BP-lowering on cardiovascular events in patients with diabetes compared to standard treatment. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted, comparing intensive treatment (target systolic BP < 130 mmHg or diastolic BP < 80 mmHg) with standard treatment in patients with diabetes. Eligible studies were identified through Ovid MEDLINE, Cochrane Library, and Ichushi. Outcomes included cardiovascular events, coronary artery disease, stroke, all-cause and cardiovascular death, and serious adverse events. Data were analyzed using a random-effects model. Sensitivity analyses were performed to assess the effects of systolic and diastolic BP targets separately. The search identified eight eligible trials comprising 16634 patients with diabetes. Intensive BP-lowering treatment significantly reduced cardiovascular events (risk ratio: 0.848; 95% confidence interval: 0.760, 0.947) and stroke (risk ratio: 0.705; 95% confidence interval: 0.541, 0.918), but not coronary artery disease or all-cause death in analyses including J-DOIT3 trial. Sensitivity analyses showed that DBP-targeted treatment was not associated with the risk of cardiovascular events. Incorporating the latest RCT strengthened the association between intensive treatment and reduced coronary artery disease risk, without significantly increasing the risk of serious adverse events. These findings recommend an intensive BP-lowering strategy targeting SBP < 130 mmHg or DBP < 80 mmHg to prevent cardiovascular events, particularly stroke, in patients with diabetes.

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Funding

This research was supported by Fukuoka University (GW2324).

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Authors and Affiliations

  1. Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan

    Makiko Abe & Hisatomi Arima

  2. Omihachiman Community Medical Center, Shiga, Japan

    Hiroyoshi Segawa

  3. Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan

    Sho Kinguchi

  4. Laboratory of Epidemiology and Prevention, Kobe Pharmaceutical University, Kobe, Japan

    Atsushi Satoh

  5. Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan

    Ryo Zamami

  6. Department of Cardiovascular Medicine, National Hospital Organization Kobe Medical Center, Kobe, Japan

    Toshiyuki Nishikido

  7. Department of Cardiovascular Medicine, Saga University, Saga, Japan

    Atsushi Tanaka & Koichi Node

  8. Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan

    Hirofumi Ohnishi

  9. Japan Healthcare University, Sapporo, Japan

    Shigeyuki Saitoh

  10. Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan

    Masato Furuhashi

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Correspondence to Makiko Abe.

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Abe, M., Segawa, H., Kinguchi, S. et al. Intensive blood pressure-lowering treatment to prevent cardiovascular events in patients with diabetes: a systematic review and meta-analysis. Hypertens Res 48, 2024–2033 (2025). https://doi.org/10.1038/s41440-025-02209-9

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