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Hypertension / Stroke / Cardiovascular Diseases · Journal article
Annals of Medicine · April 30, 2026
Well-designed and adequately powered for the question it asks.
This meta-analysis of 31 randomized controlled trials involving 156,933 participants demonstrates that intensive blood pressure control (targeting SBP <120 or <130 mmHg) significantly reduces major cardiovascular events, myocardial infarction, stroke, all-cause mortality, and cardiac death compared to standard control (SBP <140 mmHg). The consistency of benefit across multiple endpoints and sensitivity analyses supports the robustness of these findings, though heterogeneity by clinical subgroups and lack of comprehensive adverse event reporting warrant cautious individualized application.
Systematic review and meta-analysis of randomized controlled trials. Patients with hypertension enrolled in randomized controlled trials; mean age range of trial populations 36.6 to 83.6 years; male proportion 34.5% to 69.4%.. Intervention: Intensive blood pressure control, typically targeting systolic BP <120 or <130 mmHg. Compared with: Standard blood pressure control, typically targeting systolic BP <140 mmHg. n = 156,933.
Intensive BP control reduced major cardiovascular events with RR 0.80 (95% CI: 0.75-0.84; p < 0.001) Myocardial infarction risk reduced with RR 0.83 (95% CI: 0.76-0.91; p < 0.001) Stroke risk reduced with RR 0.76 (95% CI: 0.70-0.82; p < 0.001)
Adverse events (hypotension, renal dysfunction, electrolyte disturbances) not described or quantified All-cause mortality reduced with RR 0.87 (95% CI: 0.83-0.92; p < 0.001)
These findings provide strong evidence supporting adoption of lower blood pressure targets in clinical practice; however, the source emphasizes that treatment effects varied by sample size, male proportion, smoking prevalence, diabetes status, and follow-up duration, indicating that individualized patient assessment remains essential to determine appropriateness of intensive control in specific populations.
Large meta-analysis of 31 RCTs with 156,933 participants demonstrates consistent, statistically significant reductions across multiple cardiovascular endpoints with narrow confidence intervals; evidence quality limited by heterogeneity across trials and absence of reported adverse event data.
As stated by the source record.
Quoted from the source exactly as published.
These findings provide strong evidence supporting adoption of lower blood pressure targets in clinical practice; however, the source emphasizes that treatment effects varied by sample size, male proportion, smoking prevalence, diabetes status, and follow-up duration, indicating that individualized patient assessment remains essential to determine appropriateness of intensive control in specific populations.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background. This meta-analysis systematically evaluated the impact of intensive (typically targeting systolic BP [SBP] <120 or <130 mmHg) versus standard (typically targeting SBP <140 mmHg) blood pressure control on cardiovascular outcomes in patients with hypertension.Materials and methods. Relevant randomized controlled trials (RCTs) published up to May 2025 were identified through systematic searches of PubMed, Embase, Web of Science, and the Cochrane Library. A random-effects model was used to calculate pooled relative risks (RRs) with 95% confidence intervals (CIs).Results. Thirty-one RCTs involving a total of 156,933 participants (mean age range of trial populations: 36.6 to 83.6 years; proportion of male participants: 34.5% to 69.4%; follow-up duration: 1.8 to 19.3 years) were included in the final meta-analysis. Compared to standard blood pressure control, intensive control significantly reduced the risk of major cardiovascular events (RR: 0.80; 95% CI: 0.75-0.84; p < 0.001), myocardial infarction (RR: 0.83; 95% CI: 0.76-0.91; p < 0.001), stroke (RR: 0.76; 95% CI: 0.70-0.82; p < 0.001), all-cause mortality (RR: 0.87; 95% CI: 0.83-0.92; p < 0.001), and cardiac death (RR: 0.79; 95% CI: 0.73-0.86; p < 0.001). Sensitivity analyses confirmed the robustness of these findings. Additionally, the treatment effects varied by sample size, male proportion, smoking prevalence, diabetes status, and follow-up duration.Conclusion. Intensive blood pressure control (typically targeting SBP <120 or <130 mmHg) is strongly associated with a reduced risk of cardiovascular events. These findings support adopting lower blood pressure targets in clinical practice while emphasizing the need for individualized patient assessment.
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