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