In 9,476 adults in Brazil with type 2 diabetes and high cardiovascular risk, a systolic target under 120 mm Hg did not reduce major events versus under 140

What the research found

NEJM published a multicenter open-label randomized trial on 7 November 2026. Karla Santo and colleagues in Brazil enrolled adults with elevated blood pressure, type 2 diabetes, and high cardiovascular risk. The intensive arm targeted systolic pressure under 120 mm Hg. The standard arm targeted systolic pressure under 140 mm Hg. The primary composite was cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or a hospital stay for unstable angina or heart failure. 9,476 people enrolled, 4,745 in the intensive arm and 4,731 in the standard arm. Median follow-up was 4.0 years (IQR 3.9 to 4.0). The primary outcome occurred in 286 people (6.0 percent; 1.65 events per 100 person-years) versus 315 people (6.7 percent; 1.83 per 100 person-years). The hazard ratio was 0.90 (95 percent CI 0.77 to 1.06, P = 0.20). Serious adverse events were 706 (14.9 percent) versus 693 (14.6 percent). The trial conclusion is that a target under 120 mm Hg did not reduce major cardiovascular events compared with a target under 140 mm Hg. The NEJM abstract used here does not give age or sex, so this card is not tagged to an age band or a sex. A same-day American Heart Association news release on this trial said kidney-related events were 270 (5.7 percent) versus 175 (3.7 percent), mainly declines in kidney function, with end-stage kidney disease similar. That kidney count is from the news release, not from the abstract paragraph used here. These are trial results, not a personal pressure target. DOI 10.1056/NEJMoa2612922. Not medical advice.

Evidence level: Clinical trial. This is among the stronger kinds of evidence, but one study rarely settles a question.

Read the original at NEJM