This review focuses on the assumption of mortality outcome of participants remaining label hypertension care is adequately managed when pressure targets are met with both qualitative and quantitaive method.

For systematically review and synthesize the literature on main 2 questions

1. Why do mortality outcomes still occur despite intervention of high blood pressure?
2. What is the framework of high blood pressure death?

For Individual Participant Data Meta-analysis will be attracted from final analysis articles from the framework of data selection process only, the effect measurement and multi-variable model meta-analysis will be performed.

Sub-group analysis effect measurement following;

• Types and causes of death in patients with well-controlled hypertension.
• Underlying evidence or proposed mechanisms, biological markers, or comorbid conditions contribute to death despite optimal treatment.
• Treatment-related limitations, co-factors, and syndromes leading to uncontrolled fatal outcomes.
• Analyze possible mechanisms of cardiovascular death in controllable even intensive blood pressure control participants.

• Inclusion:

  • Human birth in all sex chromosomes.

  • Study reports evidence of living with owned systemic/arterial hypertension by one of definition following;

    • Quantitative: Blood pressure number higher over the normal range by each protocol in mmHg unit in any arm of study.
    • Qualitative: Clarify the underwent both retrospective, observation or intervention of blood pressure and clearly clarify number of hypertension participants in article.

  • Study design: any type of studies and have a doi number.

    • In case report type study, the article recruit in only high blood pressure is a burden that reports both direct intervention for blood pressure or indirect intervention such as treatment of vascular damage from high blood pressure.
    • In a group of literature review type study, the number of hypertension participants with references from both in supplementary document or traced back via each doi number have to clearly declare in that free full-text and currently non-retracted article without personal requirement as raw material to processing the individual participant data meta-analysis

  • Study recruit only last version of study series that have to confirm published the hypertension participant with mortality outcomes.

  • English-language studies.

• Exclusion:

  • Non human/human-specimen studies.
  • Evidence confirms local site or specific system hypertension only such as studies of pulmonary hypertension, portal hypertension, ocular hypertension without clearly defining the number of systemic arterial hypertension in articles.
  • No report of conclusion of participant such as no mortality report, no failed/successful outcome from last follow up from hypertension associated life-threatening event.
  • Deaths due to suicide, trauma, or illegal drugs including intend to take medication overdose in any reason.
  • Book, Testimonial, Interview, Conference, Protocol articles.
  • Sub-group analysis.
  • Duplicate one of the doi/nct/prospero numbers.
  • No doi. Number

Studies including patients (any age or sex) with:

• Interventional treatment for hypertension
• Documented blood pressure control (as defined by each primary study)
• Reported mortality or fatal outcome

The study already registered from PROSPERO number CRD420251072526

TIMELINE OF THE REVIEW Date of first submission to PROSPERO 01 July 2025 Review timeline Start date: 14 June 2025. End date: 31 December 2026.

Date of registration in PROSPERO

01 July 2025

Public registered