Clinical Trials to Specifically Evaluate Lower BP Goals Data from controlled trials designed primarily to evaluate lower BP goals in hypertensive subjects have not shown a J curve. Population-based studies suggest that 45% of white adults with diabetes mellitus have coronary heart disease compared with 25% in nondiabetic individuals.151 This makes the ACCORD study relevant to the issue of BP targets in patients with CAD. ACCORD was a trial to evalu- ate the overall effects of intensified glycemic control, inten- sive BP lowering, and reduced triglyceride levels in patients with type 2 diabetes mellitus and other risk factors for CVD. The BP study20 randomized 4733 patients, of whom 34% had had a previous cardiovascular event, to an intensive therapy arm, with an SBP target of <120 mmHg, or to standard ther- apy, targeting an SBP of <140 mmHg. After 1 year, the mean SBP was 119.3 mmHg in the intensive therapy group, and 133.5 mmHg in the standard therapy group, a difference of 14 mmHg. During the mean follow-up of 4.7 years, there was no significant difference between the 2 groups with respect to the primary composite outcome (nonfatal MI, nonfatal stroke, or death resulting from cardiovascular causes), nonfa- tal MI, all-cause mortality, cardiovascular death, major coro- nary disease event, or fatal or nonfatal HF. However, the risk of the primary composite end point was numerically lower (by 12%) in those randomized to the lower goal. Similarly, the risk of MI was lower (by 13%) in the group randomized to the lower BP target, but this was not statistically significant. There was a putatively significantly lower incidence of stroke in the intensive therapy group (ie, uncorrected for multiple comparisons), but the number of strokes was small (at 98). 