{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T04:55:09Z","timestamp":1781499309504,"version":"3.54.1"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although guidelines recommend lower blood pressure targets for patients with type 2 diabetes (T2D), evidence from randomized controlled trials (RCTs) remains inconsistent regarding the balance between reducing major adverse cardiovascular events (MACE) and the risk of adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This meta-analysis included RCTs comparing intensive versus conventional blood pressure control in patients with T2D. The primary outcome was MACE, and secondary outcomes included adverse events. Data were synthesized using a random-effects model. Subgroup analyses were conducted to assess the influence of different blood pressure targets and concomitant intensive glucose or lipid management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nine trials comprising 34,260 participants with T2D were included. Intensive blood pressure control was associated with a significantly lower risk of MACE compared with conventional control [7.9% vs 9.7%; risk ratio (RR), 0.80; 95% CI, 0.73\u20130.89;\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001]. Among individual MACE components, intensive treatment significantly lowered the risk of stroke (RR, 0.73; 95% CI, 0.60\u20130.87; P = 0.008), whereas no significant differences were observed for heart failure, myocardial infarction and cardiovascular death risk. Subgroup analyses suggested a potentially treatment benefit in trials aiming for a systolic blood pressure (SBP) target of &amp;lt;130 mm Hg and incorporating an explicit diastolic blood pressure (DBP) target Concomitant intensive glucose or lipid control did not significantly modify the treatment effect. Regarding safety, intensive treatment was associated with a borderline increased risk of hypotension (RR, 4.61; 95% CI, 1.01\u201320.99;\n                      <jats:italic>P<\/jats:italic>\n                      = 0.05) but not with other adverse events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Intensive blood pressure control significantly reduces the risk of MACE in patients with T2D. Strategies incorporating explicit DBP targets may offer substantial benefits. However, it should be paid attention to monitoring and preventing adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/<\/jats:ext-link>\n                      , identifier CRD420251266814.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1850865","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T04:28:38Z","timestamp":1781497718000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Intensive blood pressure control in type 2 diabetes: a meta-analysis of randomized controlled trials"],"prefix":"10.3389","volume":"17","author":[{"given":"Zeguang","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Henan University","place":["Kaifeng, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junfeng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Henan University","place":["Kaifeng, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenguang","family":"Niu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Henan University","place":["Kaifeng, China"]},{"name":"Central Laboratory, Henan University School of Stomatology","place":["Kaifeng, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.16.2.434","article-title":"Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial","volume":"16","author":"Stamler","year":"1993","journal-title":"Diabetes Care"},{"key":"B2","unstructured":"IDF diabetes atlas 11th edition\n          \n          \n          \n          2025"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.316.7134.823","article-title":"Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23)","volume":"316","author":"Turner","year":"1998","journal-title":"BMJ"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000001356","article-title":"2025 AHA\/ACC\/AANP\/AAPA\/ABC\/ACCP\/ACPM\/AGS\/AMA\/ASPC\/NMA\/PCNA\/SGIM guideline for the prevention, detection, evaluation and management of high blood pressure in adults: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"152","author":"Jones","year":"2025","journal-title":"Circulation"},{"key":"B5","doi-asserted-by":"publisher","first-page":"3912","DOI":"10.1093\/eurheartj\/ehae178","article-title":"2024 ESC guidelines for the management of elevated blood pressure and hypertension","volume":"45","author":"McEvoy","year":"2024","journal-title":"Eur Heart J"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1511939","article-title":"A randomized trial of intensive versus standard blood-pressure control","volume":"373","author":"Wright","year":"2015","journal-title":"N Engl J Med"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2412006","article-title":"Intensive blood-pressure control in patients with type 2 diabetes","volume":"392","author":"Bi","year":"2025","journal-title":"N Engl J Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1001286","article-title":"Effects of intensive blood-pressure control in type 2 diabetes mellitus","volume":"362","author":"Cushman","year":"2010","journal-title":"N Engl J Med"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/s2213-8587(17)30327-3","article-title":"Effect of an intensified multifactorial intervention on cardiovascular outcomes and mortality in type 2 diabetes (J-DOIT3): an open-label, randomised controlled trial","volume":"5","author":"Ueki","year":"2017","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.3111","article-title":"Intensive versus standard multifactorial cardiovascular risk factor control in screen-detected type 2 diabetes: 5-year and longer-term modelled outcomes of the ADDITION-Leicester study","volume":"35","author":"Webb","year":"2019","journal-title":"Diabetes Metab Res Rev"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcd.2025.07.007","article-title":"Effects of intensive blood pressure control on cardiovascular outcomes in patients with diabetes: a systematic review and meta-analysis","volume":"19","author":"Saad","year":"2025","journal-title":"Prim Care Diabetes"},{"key":"B12","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1093\/ajh\/hpaf140","article-title":"Intensive blood pressure control in type 2 diabetes: a systematic review and meta-analysis of cardiovascular and microvascular outcomes","volume":"39","author":"Mousavi","year":"2025","journal-title":"Am J Hypertens"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1038\/s41440-025-02209-9","article-title":"Intensive blood pressure-lowering treatment to prevent cardiovascular events in patients with diabetes: a systematic review and meta-analysis","volume":"48","author":"Abe","year":"2025","journal-title":"Hypertens Res"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(86)90046-2","article-title":"Meta-analysis in clinical trials","volume":"7","author":"DerSimonian","year":"1986","journal-title":"Control Clin Trials"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v036.i03","article-title":"Conducting meta-analyses in R with the metafor package","volume":"36","author":"Viechtbauer","year":"2010","journal-title":"J Stat Software"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1009","article-title":"A refined method for the meta-analysis of controlled clinical trials with binary outcome","volume":"20","author":"Hartung","year":"2001","journal-title":"Stat Med"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.10.007","article-title":"Trial sequential analysis reveals insufficient information size and potentially false positive results in many meta-analyses","volume":"61","author":"Brok","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)01028-6","article-title":"Lowering systolic blood pressure to less than 120 mm Hg versus less than 140 mm Hg in patients with high cardiovascular risk with and without diabetes or previous stroke: an open-label, blinded-outcome, randomised trial","volume":"404","author":"Liu","year":"2024","journal-title":"Lancet"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1001\/jama.299.14.1678","article-title":"Effect of lower targets for blood pressure and LDL cholesterol on atherosclerosis in diabetes: the SANDS randomized trial","volume":"299","author":"Howard","year":"2008","journal-title":"JAMA"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e965-74","DOI":"10.1016\/j.jare.2025.09.054","article-title":"Evaluating intensive blood pressure control versus usual care on cardiovascular disease in patients with diabetes using win statistics: a subgroup analysis of a cluster randomized trial","volume":"84","author":"Sun","year":"2025","journal-title":"J Adv Res"},{"key":"B23","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1186\/s12933-021-01343-1","article-title":"Efficacy and durability of multifactorial intervention on mortality and MACEs: a randomized clinical trial in type-2 diabetic kidney disease","volume":"20","author":"Sasso","year":"2021","journal-title":"Cardiovasc Diabetol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.ejim.2023.04.019","article-title":"The influence of baseline glycemic status on the effects of intensive blood pressure lowering: results from the STEP randomized trial","volume":"113","author":"Yang","year":"2023","journal-title":"Eur J Intern Med"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(22)02603-4","article-title":"Effectiveness of a non-physician community health-care provider-led intensive blood pressure intervention versus usual care on cardiovascular disease (CRHCP): an open-label, blinded-endpoint, cluster-randomised trial","volume":"401","author":"He","year":"2023","journal-title":"Lancet"},{"key":"B26","doi-asserted-by":"publisher","first-page":"21i","DOI":"10.1016\/j.amjcard.2007.03.003","article-title":"Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: design and methods","volume":"99","author":"Buse","year":"2007","journal-title":"Am J Cardiol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2111437","article-title":"Trial of intensive blood-pressure control in older patients with hypertension","volume":"385","author":"Zhang","year":"2021","journal-title":"N Engl J Med"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-022-01974-1","article-title":"Effects of elevated systolic blood pressure on ischemic heart disease: a burden of proof study","volume":"28","author":"Razo","year":"2022","journal-title":"Nat Med"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(14)60685-1","article-title":"Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1\u00b725 million people","volume":"383","author":"Rapsomaniki","year":"2014","journal-title":"Lancet"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1161\/01.Str.0000116869.64771.5a","article-title":"Blood pressure and stroke: an overview of published reviews","volume":"35","author":"Lawes","year":"2004","journal-title":"Stroke"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht108","article-title":"ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD)","volume":"34","author":"Ryd\u00e9n","year":"2013","journal-title":"Eur Heart J"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1007\/s11357-025-02025-6","article-title":"A novel clinical biomarker-based physiology healthy aging index and risk of all-cause and cause-specific mortality: a 20-year prospective cohort study","author":"Lyu","year":"2025","journal-title":"GeroScience"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000000597","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary: A report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"138","author":"Whelton","year":"2018","journal-title":"Circulation"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(98)04311-6","article-title":"Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial","volume":"351","author":"Hansson","year":"1998","journal-title":"Lancet"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.05.073","article-title":"The J-curve between blood pressure and coronary artery disease or essential hypertension: exactly how essential","volume":"54","author":"Messerli","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.05.075","article-title":"Low diastolic blood pressure is associated with angina in patients with chronic coronary artery disease","volume":"72","author":"Peri-Okonny","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.122.18997","article-title":"Another nail in the coffin of causality for the diastolic blood pressure J curve","volume":"79","author":"Birrane","year":"2022","journal-title":"Hypertension"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.37554","article-title":"Evaluation of optimal diastolic blood pressure range among adults with treated systolic blood pressure less than 130 mm Hg","volume":"4","author":"Li","year":"2021","journal-title":"JAMA Netw Open"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.122.20112","article-title":"Diastolic blood pressure and intensive blood pressure control on cognitive outcomes: Insights from the SPRINT MIND trial","volume":"80","author":"Jiang","year":"2023","journal-title":"Hypertension"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-1779","article-title":"Results from a randomized trial of intensive glucose management using CGM versus usual care in hospitalized adults with type 2 diabetes: the TIGHT study","volume":"48","author":"Hirsch","year":"2025","journal-title":"Diabetes Care"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.2337\/dc19-1817","article-title":"Effects of intensive glycemic control on clinical outcomes among patients with type 2 diabetes with different levels of cardiovascular risk and hemoglobin A1c in the ADVANCE trial","volume":"43","author":"Tian","year":"2020","journal-title":"Diabetes Care"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1006524","article-title":"Long-term effects of intensive glucose lowering on cardiovascular outcomes","volume":"364","author":"Gerstein","year":"2011","journal-title":"N Engl J Med"},{"key":"B43","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.pcad.2025.11.003","article-title":"Lipid management for primary and secondary stroke prevention consensus paper of the International Lipid Expert Panel (ILEP)","volume":"94","author":"Banach","year":"2025","journal-title":"Prog Cardiovasc Dis"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1007\/s11883-009-0037-3","article-title":"Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein","volume":"11","author":"Liao","year":"2009","journal-title":"Curr Atheroscler Rep"},{"key":"B45","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.amjmed.2005.09.014","article-title":"Improved outcome after acute coronary syndromes with an intensive versus standard lipid-lowering regimen: results from the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) trial","volume":"118","author":"Rouleau","year":"2005","journal-title":"Am J Med"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.0179","article-title":"Intensive vs conventional blood pressure control after thrombectomy in acute ischemic stroke: a systematic review and meta-analysis","volume":"7","author":"Ghozy","year":"2024","journal-title":"JAMA Netw Open"},{"key":"B47","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(25)01391-1","article-title":"Benefit-harm trade-offs of intensive blood pressure control versus standard blood pressure control on cardiovascular and renal outcomes: an individual participant data analysis of randomised controlled trials","volume":"406","author":"Guo","year":"2025","journal-title":"Lancet"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.125.25162","article-title":"Benefit and harm of intensive blood pressure control by cardiovascular risk","volume":"82","author":"Dong","year":"2025","journal-title":"Hypertension"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(07)61303-8","article-title":"Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial","volume":"370","author":"Patel","year":"2007","journal-title":"Lancet"},{"key":"B50","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1016\/s0140-6736(05)67185-1","article-title":"Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial","volume":"366","author":"Dahl\u00f6f","year":"2005","journal-title":"Lancet"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(04)16451-9","article-title":"Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial","volume":"363","author":"Julius","year":"2004","journal-title":"Lancet"},{"key":"B52","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1016\/s0140-6736(02)08089-3","article-title":"Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol","volume":"359","author":"Dahl\u00f6f","year":"2002","journal-title":"Lancet"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.23.2981","article-title":"Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)","volume":"288","year":"2002","journal-title":"JAMA"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(25)00991-2","article-title":"Blood pressure-lowering efficacy of antihypertensive drugs and their combinations: a systematic review and meta-analysis of randomised, double-blind, placebo-controlled trials","volume":"406","author":"Wang","year":"2025","journal-title":"Lancet"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1850865\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T04:28:47Z","timestamp":1781497727000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1850865\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,15]]},"references-count":54,"alternative-id":["10.3389\/fendo.2026.1850865"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1850865","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,15]]},"article-number":"1850865"}}