Abstract
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.