The frequency of macroalbuminuria at the final visit was significantly lower with intensive therapy than with standard therapy, and there was no between-group difference in the frequency of kidney failure or initiation of dialysis (in 58 patients vs. 59 patients, P 0.93).159 The ACCORD trial also showed that intensive glycemic control and combination lipid-lowering treatment, but not intensive BP control, was associated with a reduction in the rate of progression of retinopathy.224 Observational studies. There have been several large observational studies of patients with diabetes, CKD, or both, most of which found a lower risk of cardiovascular or kidney outcomes in people with lower BP.148,225 These studies have been cited by many previous guidelines and used to support a BP target of o130/80 mm Hg for patients with CKD or diabetes. However, none of these studies prove causality and it is equally possible that higher BP, whether occurring before initiation of BP-lowering treatment or after, is simply a marker for more severe disease, which in turn has a poorer prognosis.22 Among patients screened for the Multiple Risk Factor Intervention (MRFIT) trial, there was a strong, graded, positive relationship between baseline BP and subsequent risk of kidney failure; the association was weaker among older men, blacks, and men with diabetes.148 In the diabetic subgroup of MRFIT participants,201 the risk of cardiovascular death increased to a greater degree with increasing risk factors, including systolic BP, than in the non-diabetic subgroup. A strong association between baseline BP and subsequent risk of kidney failure was also demonstrated in an Okinawan After adjustment for age and BMI, there was a significant, positive association between systolic BP and the risk of diabetic kidney failure, with a relationship also demonstrated for diastolic BP in women only. 