P254 - EFFECT OF INTENSIVE VS STANDARD BLOOD PRESSURE CONTROL ON CARDIOVASCULAR OUTCOMES AND MORTALITY IN PATIENTS WITH TYPE 2 DIABETES: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background: Hypertension and diabetes frequently coexist, amplifying cardiovascular risk. Despite robust evidence supporting blood pressure (BP) reduction in individuals with diabetes, the optimal target for systolic BP remains uncertain. Inconsistent findings across clinical trials have resulted in varying guideline recommendations. We aimed to clarify this uncertainty by systematically reviewing the outcomes of intensive versus standard BP control.

METHODS AND RESULTS: A comprehensive systematic review was conducted using Medline, EMBASE, and CENTRAL, which were searched up to December 2024. Randomized controlled trials involving participants aged 18 years or older with a diagnosis of type 2 diabetes and comparing intensive blood pressure control with standard blood pressure control were included. Outcomes assessed included major adverse cardiovascular events (MACE), stroke, myocardial infarction (MI), heart failure, cardiovascular mortality, and all-cause mortality. Random-effects meta-analyses were used to estimate pooled odds ratios and confidence intervals.
Five studies were included in the systematic review. The results of meta-analysis model indicated that intensive intervention significantly decreased the incidence of major adverse cardiovascular events (MACE) [OR 0.86 (95%CI 0.77 to 0.96), (p = 0.01), I2 = 17.10%], and stroke [OR 0.75 (95%CI 0.62 to 0.91), (p > 0.001), I2 = 14.30%]. However, the results did not show any significant effect of intensive intervention compared to standard intervention on myocardial infarction (MI), cardiovascular-related mortality, heart failure, or all-cause mortality in patients with diabetes.

Conclusion: Intensive BP control in diabetes significantly lowers stroke and MACE risk, supporting its potential benefit. However, neutral effects on MI, mortality, and heart failure highlights the need for patients-based strategies and further research to optimize patient-specific outcomes.