- Question
- Is lowering systolic blood pressure to below 120 mm Hg superior to a target below 140 mm Hg in hypertensive patients at high cardiovascular risk, including those with diabetes or previous stroke?
- Design
- Open-label, blinded-outcome randomised trial using minimised randomisation at 116 hospitals or communities in China. A total of 11255 participants were assigned (4359 with diabetes and 3022 with previous stroke), with a median follow-up of 3.4 years.
- Population
- Hypertensive adults at high cardiovascular risk, with a mean age of 64.6 years, with and without diabetes or previous stroke.
- Intervention
- Intensive treatment targeting standard office systolic blood pressure below 120 mm Hg, with a two- or three-drug regimen started in most participants and stepwise titration (n=5624).
- Control
- Standard treatment targeting systolic blood pressure below 140 mm Hg (n=5631).
- Primary outcome
- Composite of myocardial infarction, revascularisation, hospitalisation for heart failure, stroke, or death from cardiovascular causes, analysed by intention to treat.
- Results
- Mean systolic blood pressure during follow-up was 119.1 mm Hg with intensive treatment and 134.8 mm Hg with standard treatment. The primary outcome occurred in 547 participants (9.7%) in the intensive group and 623 (11.1%) in the standard group (HR 0.88, 95% CI 0.78-0.99; p=0.028), with no heterogeneity by diabetes status, diabetes duration or history of stroke.
- Safety
- Serious syncope was more frequent with intensive treatment (24 [0.4%] vs. 8 [0.1%]; HR 3.00, 95% CI 1.35-6.68). There were no significant differences in serious hypotension, electrolyte abnormality, injurious fall or acute kidney injury.
- Conclusion
- In hypertensive patients at high cardiovascular risk, targeting systolic blood pressure below 120 mm Hg reduced major vascular events compared with below 140 mm Hg, with a minor excess risk, regardless of diabetes or previous stroke.
- Why it matters
- It adds evidence supporting tighter blood pressure control in high-risk patients, including those with diabetes and previous stroke, and supports considering lower systolic targets while monitoring for adverse effects.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026