Intensive vs. conventional blood pressure goals in older patients with type 2 diabetes: a systematic review and meta-analysis

Purpose Assess the effect of intensive vs conventional blood pressure goals on patient-important outcomes in older adults with type 2 diabetes. Methods A comprehensive search was performed using electronic databases. Randomized controlled trials comparing intensive vs conventional blood pressure goals in adults over 60 years of age with type 2 diabetes were included. Events were evaluated using a modified Mantel-Haenszel meta-analysis with Peto’s method. Study selection and data extraction were performed independently and in duplicate. Results Seven trials were included. A 19% risk reduction (OR 0.81; 95% CI 0.69–0.95; I 2 = 8%; p = 0.35) in the occurrence of major adverse cardiovascular events (MACE) and 37% risk reduction (OR 0.63; 95% CI 0.51–0.79; I 2 = 0%; p = 0.56) in the occurrence of fatal or non-fatal stroke was documented in the intensive treatment group. There were no differences in the occurrence of all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and peripheral vascular disease. Data regarding treatment adverse effects and microvascular outcomes was scarce. Conclusions Intensive blood pressure goals in older patients with diabetes were associated with a lower risk of stroke and MACE, but not with all-cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and peripheral vascular disease. Highlights This is the first review on the effect of intensive blood pressure goals in older patients who have diabetes. This analysis provides evidence that intensive blood pressure goals in older patients with diabetes are associated with a lower risk of stroke and MACE. There were no differences in all-cause mortality, CV mortality, non-fatal myocardial infarction, and peripheral vascular disease. The pros and cons of an intensive approach should be discussed with patients given that it could increase the number of medications, cost, and adverse events. Clinicians should address these results with caution, as the estimates are not robust enough to recommend a specific blood pressure goal due to the heterogeneity of goals and interventions among the included studies.