Lowering systolic blood pressure below 120 mm Hg in adults with Type 2 diabetes did not significantly reduce the incidence of cardiovascular death, stroke, heart attack or other cardiovascular events compared with standard treatment targeting less than 140 mm Hg, according to preliminary late-breaking science presented at the American Heart Association’s Scientific Sessions 2026 in Chicago. The findings, simultaneously published in the New England Journal of Medicine, come from the OPTIMAL-DIABETES trial, which enrolled more than 9,000 adults aged 50 and older at 33 sites in Brazil.
The study matters because people with Type 2 diabetes and high blood pressure face elevated risks of heart attacks and strokes. The American Heart Association/American College of Cardiology’s 2025 Joint Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults identifies high blood pressure as the leading preventable risk factor for cardiovascular disease, including heart attack, stroke, heart failure, kidney disease and cognitive decline. The guideline recommends a systolic target below 130 mm Hg and encourages reaching below 120 mm Hg for people at increased cardiovascular risk.
In OPTIMAL-DIABETES, participants with systolic blood pressure between 130 and 180 mm Hg were randomly assigned to intensive therapy (target <120 mm Hg) or standard therapy (target <140 mm Hg). Over a median follow-up of four years, the intensive group had about a 10% lower risk of major cardiovascular events—286 participants (6.0%) versus 315 (6.7%) in the standard group—but the difference was not statistically significant. Kidney-related events were about 55% higher in the intensive group (5.7% vs. 3.7%), primarily declines in kidney function, though end-stage renal disease rates were similar. Serious adverse events were comparable between groups.
“These findings add important evidence about optimal blood pressure targets for adults with Type 2 diabetes,” said lead author Karla Santo, M.D., Ph.D., of Einstein Hospital Israelita in São Paulo. “While this trial did not find a statistically significant reduction in major cardiovascular events, more intensive blood pressure treatment may still have modest yet meaningful health benefits.” Otavio Berwanger, M.D., Ph.D., chair of the trial’s steering committee, emphasized that “blood pressure management for people with Type 2 diabetes should remain individualized,” adding that a target below 120 mm Hg “should not necessarily be applied universally.”
The trial’s open-label design and its conduct solely in Brazil limit generalizability. Still, the results add to the evidence base at a time when cardiovascular disease remains a leading cause of death. For patients and clinicians, the findings suggest that aggressive blood pressure targets in Type 2 diabetes must be weighed against kidney risks and treatment burden. The abstract is available in the conference’s online program planner, and the full manuscript appears in the New England Journal of Medicine.
