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Intensive blood-pressure control for the prevention of major cardiovascular events in patients with type 2 diabetes:

Karla Santo1, Eduardo Martins1, Gisele S Silva2

  • 1Hospital Israelita Albert Einstein, São Paulo, Brazil.

American Heart Journal
|July 24, 2026
PubMed
Abstract

Insights

This study investigates intensive blood pressure (BP) control in type 2 diabetes (T2D). Lowering systolic BP to <120 mmHg may reduce cardiovascular events compared to <140 mmHg in high-risk T2D patients.

Area of Science:

  • Cardiology
  • Endocrinology
  • Clinical Trials

Background:

  • Uncertainty exists regarding the benefits of intensive blood pressure (BP) control in type 2 diabetes (T2D) patients.
  • This is particularly relevant in ethnically diverse populations with high cardiovascular (CV) risk.
  • The OPTIMAL-DIABETES trial addresses this gap in evidence.

Purpose of the Study:

  • To compare the efficacy of a target systolic BP (SBP) of <120 mmHg versus <140 mmHg.
  • To assess the reduction in major cardiovascular events in patients with T2D and high CV risk.

Main Methods:

  • Multicenter, 2-arm, open-label, randomized clinical trial.
  • Inclusion criteria: age ≥ 50 years, SBP 130-180 mmHg, T2D, high CV risk.
  • Primary endpoint: composite of CV mortality, myocardial infarction, stroke, and heart-related hospitalizations.

Main Results:

  • 9476 participants enrolled from 33 sites in Brazil (August 2019 - October 2021).
  • Diverse population: 62.0% women, 42.5% Mixed-race, 41.9% White, 14.5% Black.
  • Mean SBP 145.89 mmHg, mean DBP 79.48 mmHg; 96.1% on anti-hypertensive medication.

Conclusions:

  • The OPTIMAL-DIABETES trial will provide crucial evidence on intensive BP management in T2D.
  • Results will inform benefits and risks of targeting SBP <120 mmHg versus <140 mmHg.
  • Findings will be valuable for a diverse T2D population with elevated BP and high CV risk.

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