Cardiometabolic & kidney

Blood Pressure Levels and Outcomes in Type 2 Diabetes: Dose-Response Meta-Analysis of 5.87 Million Cohort Participants

J Am Coll CardiolPublished Systematic review and dose-response meta-analysis of cohort studies

Authors' conclusion

In type 2 diabetes, BP is linearly or monotonically associated with most cardiovascular and renal outcomes. Low SBP does not appear to be associated with an elevated risk of all-cause mortality compared with higher BP targets, suggesting that previously reported associations are likely due to reverse causation and unmeasured confounding.

Study context

Population
Participants with T2DM113 articles
Participants
5,875,364 participants89 cohorts
Comparison
SBP and DBP levels across a wide range
Outcome
All-cause mortality, CV and renal outcomes across BP levels
Methodological detailsone-stage mixed-effects dose-response meta-analysis, PubMed, Embase and Web of Science searched from inception to November 30, 2024
  • One-stage mixed-effects dose-response meta-analysis
  • PubMed, Embase and Web of Science searched from inception to November 30, 2024

Pooled result

As reported in the abstract

  • J-shaped association of SBP with all-cause mortality
  • J-shaped associations of SBP with CV events and DBP with all-cause mortality, with flattened risks at lower blood pressure (BP) levels
  • Positive linear or monotonic trends for renal events, eGFR decline and development or progression of albuminuria

Further pooled results

Excluding studies with baseline CVD or cancer

Significantly lower risk of CV events at lower SBP levels and flattened risk of all-cause mortality

Original publication

Blood Pressure Levels and Outcomes in Type 2 Diabetes: Dose-Response Meta-Analysis of 5.87 Million Cohort Participants. J Am Coll Cardiol. Published 21 January 2026. doi:10.1016/j.jacc.2025.10.068

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