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Cardiovascular outcomes under hypothetical blood-pressure-lowering intervention in type 2 diabetes: A target trial

Xue Tian1,2,3,4, Shouling Wu5, Xue Xia1,2,3,4

  • 1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Diabetes, Obesity & Metabolism
|January 20, 2026
PubMed
Abstract

Insights

Lowering systolic blood pressure (SBP) below 120 mmHg in type 2 diabetes patients may increase mortality risk. While lower SBP targets reduce cardiovascular disease (CVD) risk, SBP ≤120 mmHg is not optimal for overall mortality in this population.

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Epidemiology

Background:

  • Systolic blood pressure (SBP) control targets for patients with type 2 diabetes mellitus (T2DM) remain inconsistent.
  • The risk-benefit profile of intensive SBP reduction on cardiovascular disease (CVD) and mortality in T2DM is not fully elucidated.

Purpose of the Study:

  • To evaluate the emulated effect of maintaining SBP below specific clinical thresholds (140, 130, and 120 mmHg) on the risk of CVD and all-cause mortality in patients with T2DM.
  • To determine the optimal SBP target for balancing CVD risk reduction and all-cause mortality in diabetic patients.

Main Methods:

  • A cohort of 4264 patients with T2DM from the Kailaun study was analyzed.
  • The parametric g-formula was used to simulate hypothetical interventions for reducing SBP over time.
  • Time-varying confounding was accounted for, and risk ratios (RR) and number needed to treat (NNT) for 10-year CVD and all-cause mortality risks were reported.

Main Results:

  • Maintaining SBP below 140, 130, and 120 mmHg was associated with 18%, 24%, and 31% relative risk reductions in CVD, respectively.
  • Significant benefits for all-cause mortality were not observed for SBP targets of 140 or 130 mmHg.
  • Maintaining SBP ≤120 mmHg significantly increased all-cause mortality by 15% and showed potential harm in older patients or those not on antihypertensive medication.

Conclusions:

  • For Chinese patients with type 2 diabetes, maintaining SBP ≤120 mmHg may not be an optimal target due to unfavorable risk-benefit associations concerning CVD and all-cause mortality.
  • The findings suggest a need for individualized SBP targets in diabetic patients, considering potential risks of overly intensive blood pressure lowering.
Keywords:
SBP lowering interventionall‐cause mortalitycardiovascular diseasediabetestarget trial emulation

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