A meta-analysis from the Blood Pressure Lowering Treatment Trialists Collaboration, which included trials of antihypertensive drugs versus placebo and trials of different BP targets, found that the proportional reduction in CV events with more intensive BP treatment was independent of the presence or absence of CKD.110 In their meta-analysis, Ettehad et al. also reported a risk reduction for CVevents with intensive BP lowering in those with CKD, but the size of the risk reduction was less than that in those without CKD.105 SPRINT intentionally included a CKD subgroup a priori and examined an SBP target of <120 mm Hg, as recom- mended in the present guideline, versus <140 mm Hg. In the primary analysis of the entire cohort of 9361 participants, SPRINT demonstrated bene ts for the primary CV outcome (hazard ratio [HR]: 0.75; 95% con dence interval [CI]: 0.64 0.89) and for all-cause death (HR: 0.73; 95% CI: 0.60 0.90) across all subgroups with no heterogeneity, including those with or without CKD de ned as eGFR 20 to <60 ml/min per , with proteinuria <1 g/d.91,93 Indeed, in the sub- group with CKD (median albumin-creatinine ratio [ACR]: ), the CV bene t chapter 3 www.kidney-international.org missed signi cance of P < 0.05 (HR: 0.81; 95% CI: 0.63 1.05), while the mortality bene t was nominally signi cant. That said, SPRINT was not powered for subgroup analyses, especially given that it ended early because of the substantial CV disease and mortality bene t. It should be noted that large RCTs with major clinical outcomes are rarely powered for a speci c subgroup, even for age or sex. Trial results should be interpreted for the entire study cohort, with effect modi ca- tion by factors de ning subgroups examined in secondary analysis. 