Effect of intensive versus standard blood pressure control on cardiovascular outcomes: a meta-analysis of randomized controlled trials

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.