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Impact of Intensive Blood Pressure Control Versus Standard Control on Cardiovascular Outcomes: A Systematic Review

Ufn Rizwanullah1, Allenki Vineesh2, Fardin Akbar Hyderi3

  • 1Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK.

Cureus
|August 7, 2025
PubMed

Insights

Intensive blood pressure control significantly reduces major adverse cardiovascular events (MACE) and cardiovascular mortality. However, it increases risks of adverse events like hypotension, requiring individualized treatment decisions for hypertension management.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Public Health

Background:

  • Hypertension is a leading non-inherited risk factor for cardiovascular disease.
  • Optimal blood pressure targets for cardiovascular disease prevention remain debated.
  • Major adverse cardiovascular events (MACE) are critical outcomes in hypertension management.

Purpose of the Study:

  • To compare intensive blood pressure control versus standard control for cardiovascular outcomes.
  • To specifically analyze the impact on major adverse cardiovascular events (MACE).
  • To evaluate the balance between benefits and risks of intensive blood pressure management.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs).
  • Searched PubMed, Embase, and Cochrane Library up to March 2025.
  • Analyzed MACE (all-cause mortality, cardiovascular mortality, MI, stroke, heart failure) and adverse events using random effects models.

Main Results:

  • Intensive blood pressure control significantly reduced MACE (RR: 0.80, 95% CI: 0.73-0.88).
  • Significant reductions observed in cardiovascular mortality (RR: 0.78), stroke (RR: 0.78), and heart failure (RR: 0.73).
  • Increased risks of hypotension, syncope, electrolyte imbalance, and acute kidney injury were associated with intensive control.

Conclusions:

  • Lower blood pressure targets offer significant cardiovascular benefits, reducing MACE, cardiovascular mortality, stroke, and heart failure.
  • These benefits must be balanced against an increased risk of adverse events.
  • Individualized treatment decisions are crucial, considering patient factors and preferences.

Keywords:
blood pressureblood pressure loweringcardiovascular outcomesmeta-analysisrenal outcomes

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