The improvements seen in the intensive-therapy group were mostly in BP and the lipid profile, with only minor differences between the two groups in glycemic control and no differences in smoking, exercise measures, or body Observational evidence. There is strong observational evidence of an association between higher BP and an increased risk of worsening kidney function.148,201,225,254,255 Diabetic patients with microalbuminuria are at increased risk of both and progressive kidney disease as compared to diabetic patients with normal albumin excretion.256 258 Reduction of the rate of urinary albumin excretion during treatment is associated with a better kidney and cardiovascular However, these associations do not prove causation, and it remains possible, albeit highly unlikely, that patients in whom the rate of urine albumin excretion declines, either spontaneously or in response to treatment, have intrinsically less severe disease than those in whom no remission occurs. RCTs examining the effects of targeting certain levels of urine albumin on clinically relevant end points are needed before it can be concluded that treatment to reduce the rate of urinary albumin excretion will improve prognosis. The Work Group therefore felt that benefits of targeting lower BP levels were likely to be greater for individuals with micro- or macroalbuminuria, so a target BP of r130/ 80 mm Hg is suggested; however, stronger evidence is required in this population, hence the grade of 2D. 4.3: We suggest that an ARB or ACE-I be used in adults with diabetes and CKD ND with urine albumin excretion of *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 Patients with diabetes and microalbuminuria are at increased risk of kidney failure and cardiovascular events. 