Nonetheless, they collectively suggest that SBP lowering decreases the CV event rate and perhaps mortality and kidney outcomes. The ACCORD trial that enrolled exclusively patients with diabetes did not show a difference in the prespeci ed primary endpoint of composite CV events between the intensive SBP target (<120 mm Hg) and standard SBP target (<140 mm Hg), but it did demonstrate a signi cant reduction in stroke (HR: 0.59; 95% CI: 0.39 0.89), a prespeci ed sec- ondary outcome, with intensive SBP lowering.92 However, ACCORD included few patients with CKD, as patients with serum creatinine >1.5 mg/dl (132 mmol/l) were excluded, and those with CKD were mostly proteinuric with well-preserved Therefore, there is little direct evidence from ACCORD alone to guide a recommendation for patients with diabetes and CKD. Nonetheless, there was no statistical interaction between CKD and intensive BP lowering on the reduction in stroke risk.119 www.kidney-international.org chapter 3 In contrast to ACCORD, SPRINT included a substantial number (n 2646) of participants with CKD. Although SPRINTspeci cally excluded patients with diabetes, 42% (n 3898) of the cohort had prediabetes, de ned as baseline fasting serum glucose >100 mg/dl [5.6 mmol/l]. A post hoc analysis of SPRINT comparing participants with and without prediabetes found that the CV and survival bene ts of intensive SBP reduction (<120 mm Hg) were similar in the 2 subgroups.120 Other secondary analyses of ACCORD data further suggest that intensive SBP lowering is bene cial. A combined post hoc analysis of SPRINT and ACCORD suggested similar CV bene ts of intensive BP-lowering therapy in the presence or absence of diabetes.121 ACCORD was not only a BP trial, but it also employed a rather complex study design. 