Although there is observational evidence that the risk of CVD is higher among diabetic patients than non-diabetic patients at any given BP, these findings do not, in the absence of RCT evidence, support a recommendation that BP should be lowered further than is recommended in diabetic patients. The Work Group is aware that this recommendation appears more conservative than the recommendations of some other international and national guidelines that recommend a BP target r130/80 mm Hg for patients with diabetes and CKD.1,9,30,237 240,243,245 247 However, there is insufficient high-quality evidence from RCTs to support a lower target for patients with diabetes and CKD (which we ) who do not have an increased urinary AER. All other guidelines have relied on observational evidence to support a lower systolic BP threshold for patients with diabetes. The Work Group did not consider the evidence from the HOT220 trials strong enough to justify a recommendation to lower the target diastolic BP to r80 mm Hg. The Work Group analyzed the evidence base for the existing guidelines carefully to ensure that the apparent departure from accepted wisdom was justified. Few existing guidelines specify how patients with normoalbuminuric CKD and diabetes should be treated with BP-lowering drugs, with the majority advising a BP target of r130/80 mmHg for all patients with diabetes, irrespective of GFR or albuminuria. Although the grades (and grading system) of these recommendations vary, all supporting statements acknowledge that the evidence is largely observational. For instance, many guidelines refer back to JNC 7,9 which qualified the recommendation with the caveat, although available data are somewhat sparse to justify the low target level of 130/80 mmHg y. 