Despite advances in antihypertensive therapy, some patients with well-controlled blood pressure still experience fatal outcomes. This paradox raises critical questions about the efficacy of blood pressure-targeted interventions and whether BP control alone ensures survival. This systematic review and meta-analysis aims to evaluate all-cause mortality and cardiovascular death among hypertensive patients who achieved BP targets in RCTs or open-label trials.

To determine whether achieving controlled blood pressure through intentional intervention (pharmacological or procedural) in RCTs or open-label studies reduces mortality (all-cause and cardiovascular) in hypertensive patients.

Sensitivity Analyses Excluding high-risk of bias studies Excluding short follow-up (<1 year)

Inclusion Criteria:

• Adults ≥18 years with diagnosed hypertension

Blood pressure controlled at target values defined by the study (e.g., <140/90 mmHg or <130/80 mmHg)

Any comorbidity allowed unless the study focuses on pregnancy or pediatric population

Exclusion Criteria:

• Observational or retrospective studies

Pediatric or pregnant participants

Case reports, editorials, or conference abstracts without full data

Studies not reporting mortality outcomes separately for controlled BP

Adults ≥18 years with diagnosed hypertension

Blood pressure controlled at target values defined by the study (e.g., <140/90 mmHg or <130/80 mmHg)

Any comorbidity allowed unless the study focuses on pregnancy or pediatric population