The Work Group could find no evidence that the balance of benefits and harms of BP-lowering therapy, or specific types of therapy, varied with the GFR other than the known risks of hyperkalemia, particularly with agents that directly interfere with renin angiotensin aldosterone system (see Chapter 2). 4.1: We recommend that adults with diabetes and CKD ND with urine albumin excretion o30 mg per 24 hours (or equivalent*) whose office BP is consistently 4140 mmHg systolic or 490mm Hg diastolic be treated with BP-lowering drugs to maintain a BP that is consistently r140 mmHg systolic and r90 mmHg *Approximate equivalents for albumin excretion rate per 24 hours expressed as protein excretion rate per 24 hours, albumin/creatinine ratio, protein/creatinine ratio, and protein reagent strip results are given in Table 1, Chapter 1. RATIONALE K RCTs that have examined various BP targets or compared active treatment with placebo, along with observation studies, have been consistent in suggesting that lowering BP so that it is consistently o140/90 mm Hg will prevent major cardiovascular events. Lowering BP to these levels is also likely to reduce the risk of progressive CKD. K The evidence for the benefit of further lowering of the BP target is mixed, with modest cardiovascular benefits in patients with diabetes partly offset by increases in the risk of serious adverse effects in trials, and inconsistency in results among observational studies using clinical trial datasets. http://www.kidney-international.org chapter 4 & 2012 KDIGO Recommendation 4.1 applies to diabetic patients with CKD, , and normal albumin excretion (normoalbuminuria) prior to the use of BP- lowering drugs such as ACE-Is or ARBs. 