Patients assigned to the lower BP target were also randomized to receive either nisoldipine or enalapril. This arm of the trial was terminated early because of a significantly higher incidence of myocardial infarction (a pre- specified secondary end point) in the nisoldipine group.222 At 5 years of follow-up, there was no difference in the rate of pre- specified kidney outcomes or cardiovascular outcomes between the group targeted to 75 mm Hg and the group targeted to 80 to 89 mmHg but a significantly lower incidence of death in the The normotensive arm in the ABCD study comprised diabetic patients (around 30% of whom had CKD, as defined on the basis of albumin excretion) with a baseline BP o140/ 90 mm Hg who were randomized to placebo or active treatment (and in that group, further randomized to either enalapril or nisoldipine) titrated to reduce the diastolic BP to 10 mm Hg below baseline.223 As compared with less- intensive treatment, intensive treatment (to the lower BP target) was not associated with any difference in the change in creatinine clearance over the study period but was associated with lower risks of progression from normo- albuminuria to microalbuminuria and from microalbumin- uria to overt proteinuria, as well as a reduced risk of stroke and of progression of retinopathy. The inclusion criteria for the normotensive arm of ABCD prevents reliable extra- polation of this finding to patients whose baseline BP is 4140/90 mm Hg. The ACCORD study159 randomized 4733 patients with diabetes and high cardiovascular risk to a systolic BP target o140 mm Hg or o120 mm Hg. A total of 39% of patients had an elevated urinary AER. There was no difference between the two groups in the primary composite end point (non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death). 