Effects of intensive systolic blood pressure control in diabetic patients: a systematic review and meta-analysis comparing <120 mmHg vs. <140 mmHg targets
Bibliographic record
Abstract
Abstract Background The optimal systolic blood pressure (SBP) target for diabetic patients remains a subject of debate. While intensive SBP control (<120 mmHg) has demonstrated cardiovascular benefits, concerns about potential adverse effects persist. This systematic review and meta-analysis aim to evaluate whether intensive SBP reduction leads to better outcomes than the standard target (<140 mmHg). Purpose We aim to conduct a systematic review and meta-analysis comparing the benefits and harms of intensive versus standard SBP targets in diabetic patients. Methods We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) that compared intensive and standard SBP targets in patients with diabetes. Statistical analysis was carried out utilizing R version 4.4.2. Heterogeneity was assessed with I² statistics; p-values inferior to 0.05 and I²>25% were considered significant heterogeneity. Results Three RCTs were included, involving a total of 9,072 participants. The incidence of all types of stroke was significantly lower in the intensive SBP control group compared to the standard group (HR 0.76; 95% CI: 0.66-0.87; p < 0.001; Figure 1). However, there was no significant reduction in all-cause mortality (HR 1.00; 95% CI: 0.86-1.17; p = 0.978), cardiovascular death (HR 0.89; 95% CI: 0.64-1.23; p = 0.483) or myocardial infarction (RR 0.86; 95% CI: 0.71-1.03; p = 0.106). A significant increase in the incidence of hypotension was observed in the intensive SBP group (HR 11.81; 95% CI: 2.78-50.22; p < 0.001; Figure 2). The incidence of syncope (HR 1.48; 95% CI: 0.63-3.49; p = 0.370) and renal failure (HR 0.28; 95% CI: 0.28-9.45; p = 0.584) were similar between groups. Conclusion Our systematic review and meta-analysis suggest that intensive SBP control reduces stroke risk but does not improve mortality or myocardial infarction and increases the risk of hypotension. An individual careful risk-benefit assessment is essential.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.026 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.033 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".