Meta-analysis of blood pressure levels and outcomes in type 2 diabetes participants

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Journal of the American College of Cardiology Published May 13, 2026 Medically reviewed May 13, 2026 Study authors: Wang Siyu, Wang Kan, Gu Haoqing, Zhang Junheng, Cai Le, Xie Wanting, Yang Qianqian, Zheng Ruizhi, Zh… PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Note that low systolic blood pressure is not linked to higher mortality risk in type 2 diabetes after excluding baseline disease.

This meta-analysis examined the relationship between blood pressure levels and clinical outcomes in a large population of participants with type 2 diabetes. The investigation focused on systolic and diastolic blood pressure in relation to all-cause mortality, cardiovascular events, and renal outcomes. The analysis included secondary outcomes such as estimated glomerular filtration rate decline and albuminuria progression. The authors observed a J-shaped association for systolic blood pressure regarding mortality and cardiovascular events, with risks appearing flattened at lower levels after adjusting for baseline conditions.

The study found positive linear or monotonic trends for renal events and kidney function decline. These findings indicate that lower blood pressure levels were associated with better renal outcomes in this specific context. The authors noted that these patterns held true even when looking at the development or progression of albuminuria. The data suggests that previously reported risks associated with lower blood pressure might be misleading.

The authors highlight that dose-response relationships between blood pressure levels and risks remain poorly characterized, particularly at lower levels. They caution that previously reported associations are likely due to reverse causation and unmeasured confounding rather than direct harm. Consequently, low systolic blood pressure does not appear to be associated with an elevated risk of all-cause mortality compared with higher targets. Clinicians should interpret these findings with caution regarding blood pressure management goals.

Study Details

Study typeMeta analysis

Sample sizen = 5,875,364

EvidenceLevel 1

PublishedMay 2026

PMID41563182

View Original Abstract ↓

BACKGROUND: The dose-response relationships between systolic and diastolic blood pressure (SBP and DBP) levels and risks of all-cause mortality, cardiovascular and renal outcomes in type 2 diabetes remain poorly characterized, particularly at lower blood pressure (BP) levels. OBJECTIVE: This study aimed to examine risk patterns of major clinical outcomes across a wide range of BP levels in participants with type 2 diabetes. METHODS: We systematically searched PubMed, Embase, and Web of Science from inception to November 30, 2024, for cohort studies assessing associations of BP levels with all-cause mortality, cardiovascular, and renal outcomes. One-stage mixed-effects dose-response meta-analysis was conducted to assess the curvilinear associations. RESULTS: A total of 89 cohorts from 113 articles of 5,875,364 participants with type 2 diabetes were identified. A J-shaped association was observed for SBP with all-cause mortality. J-shaped associations were also observed for SBP with cardiovascular events and for DBP with all-cause mortality, with flattened risks at lower BP levels. After excluding studies with participants who had baseline cardiovascular diseases or cancer, a significantly lower risk of cardiovascular events was observed at lower SBP levels, as well as a flattened risk of all-cause mortality. Positive linear or monotonic trends were observed for renal events, estimated glomerular filtration rate decline, and development or progression of albuminuria. CONCLUSIONS: 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.