Intervention
CKD, chronic kidney disease, Diabetes
BLOOD, DIABETES
Participants eligible for the BPROAD study will be randomized to one of the two systolic BP goals: <120 mm Hg for the intensive treatment group and <140 mm Hg for the standard treatment group (Figure Blood pressure treatment algorithms for the intensive and standard treatment groups. ACEI, angiotensin‐converting enzyme‐inhibitor; ARB, angiotensin receptor blocker; CCB, calcium channel blocker; CKD, chronic kidney disease; DBP, diastolic blood pressure; SBP, systolic blood pressure.For both randomized groups, protocol visit frequency will be monthly for the first 3 months after randomization, then every 3 months thereafter. Monthly visits will continue in the intensive treatment group until systolic BP <120 mm Hg (or no more titration planned) and in the standard treatment group until systolic BP <140 mm Hg (or no more titration planned). A PRN (Latin For most participants in the intensive treatment group, a two‐ or three‐drug regimen of a diuretic and either an ACEI or ARB and/or a CCB should be initiated at randomization. Drug doses should be increased and/or extra antihypertensive agents should be added at monthly visit until the participant's goal of <120 mm Hg has been reached or the study physician decides no further antihypertensive agents may be added. Milepost visits based on the ACCORD and SPRINT experience for the intensive treatment group will be scheduled every 6 months beginning at the 6‐month visit throughout the follow‐up, to assist in reaching systolic BP <120 mm Hg. If the systolic BP ≥120 mm Hg at a milepost visit, an additional agent from an antihypertensive drug class different from what is being taken should be added.A systolic BP of 135–139 mm Hg should be achieved in as many participants as possible in the standard treatment group to generate the planned differences in systolic BP between treatment groups. Changes in doses and/or choices of anti‐hypertensive agents are indicated if systolic BP is ≥160 mm Hg at a single visit or is ≥140 mm Hg at two consecutive visits. Down‐titration will be recommended after full discussion with the patient if the systolic BP is <130 mm Hg at a single visit or <135 mm Hg at two consecutive visits.Once the systolic BP goal is achieved, the antihypertensive regimen should be intensified if diastolic BP remains ≥100 mm Hg at a single visit or ≥90 mm Hg at two consecutive visits to achieve diastolic BP <90 mm Hg.The background therapy recommendations such as glucose and lipid management are based on the clinical guidelines of the Chinese Diabetes Society and the American Diabetes Association.