The Work Group, therefore, is confident that most individuals with diabetes and CKD should have their usual BP lowered to be consistently r140/90 mm Hg (hence the grade of 1B for recommendation 4.1), and that targets lower than r140/90 mm Hg could be considered on an individual basis for patients believed to be more likely to benefit than to be harmed by the treatment (e.g., patients not already on several BP-lowering agents, younger individuals, or persons at high risk of stroke). Overall, the evidence supporting the statement that systolic BP should be lowered to r140 mm Hg is at least level B. However, the evidence supporting the implication that systolic BP needs to be lowered further, for instance to r130 mm Hg, is weaker. This grading should not, therefore, be taken to imply that no further research is required on the question of lower BP targets in this group. Comparison with current guidelines. Recommendation 4.1 is consistent with recommendations made by numerous international and national guidelines for the general popula- all of which agree on a treatment goal of r140/ 90 mm Hg on the grounds that BP-lowering drugs reduce the risk of all-cause and cardiovascular mortality in people whose BP is 4140/90 mmHg. There is no reason to expect that patients with diabetes and CKD are less likely to have a benefit. 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. 