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Published on: February 28, 2013
Intensive versus standard blood pressure control in patients with and without type 2 diabetes: A systematic review
João Victor de Oliveira Ramos1, João Vitor Andrade Fernandes1, Flávia Maria Camilo Madruga de Oliveira Lima1
1Medical Sciences Center, Federal University of Paraíba, João Pessoa, Brazil.
Background:
The optimal intensity of blood pressure (BP) control in patients with and without type 2 diabetes mellitus (T2D) remains unclear.
Objectives:
We performed a systematic review and meta-analysis of randomized controlled trials comparing intensive versus standard BP control, stratified by T2D status.
Methods:
Primary outcomes were all-cause mortality and serious adverse events (SAEs); secondary outcomes included death from cardiovascular causes and occurrence of myocardial infarction (MI) and stroke. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using DerSimonian-Laird random-effects models. Heterogeneity was assessed with the I2 statistic, and leave-one-out sensitivity analyses were conducted for all outcomes.
Results:
Six trials comprising 41,210 participants were included. Intensive BP control significantly reduced death from cardiovascular causes (OR 0.72; 95% CI 0.56-0.93), incidence of MI (OR 0.85; 95% CI 0.74-0.97), and stroke (OR 0.78; 95% CI 0.68-0.89). The reduction in all-cause mortality was significant in patients without T2D (OR 0.73; 95% CI 0.59-0.90), but not in those with T2D (OR 0.99; 95% CI 0.85-1.14). Intensive control was associated with a non-significant increase in SAEs overall (OR 1.15; 95% CI 0.90-1.46), with higher estimates in patients with T2D.
Conclusions:
Intensive BP control reduces cardiovascular events and mortality in non-diabetic patients. In those with T2D, benefits are attenuated and may be counterbalanced by safety concerns. BP targets should be individualized based on diabetes status and clinical context.
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