For instance, many guidelines refer back to JNC 7,9 which qualified the recommendation with the caveat, although available data are somewhat sparse to justify the low target level of 130/80 mmHg y. The JNC 7 goes on to cite the American Diabetes Association guidelines245 and the supporting literature analysis,235 which rely on the HOT for justification of the 80 mmHg diastolic BP and on Systolic Hypertension in the Elderly Program and Systolic Hypertension in Europe (Syst-Eur) (both studies of the general population) for the 140 mmHg systolic BP target. Finally, the JNC 7 states that Epidemiological studies indicate that there is a benefit to reducing systolic BP still further to 130 mm Hg or below , citing two references, UKPDS 36229 and a study from Allegheny County that contains no data on BP.249 We have not made recommendations about the choice of the BP-lowering drug to be used in patients with CKD and diabetes who do not have elevated rates of urinary albumin excretion. Although there is some evidence that inhibitors of the renin angiotensin system might prevent an increase in particularly in the presence of higher and might also reduce cardiovascular risk, such studies have not been performed in patients with reduced GFR but normal urinary albumin excretion. In such patients, the balance of risks and benefits of the use of ACE-Is or ARBs may well differ from the balance of their use for primary prevention of diabetic kidney disease. Considerations. Most interpretations of the observational evidence predict that achieved BPs below a target of r140/ 90 mm Hg in patients with CKD and diabetes would be associated with additional benefit in the prevention of both progressive kidney disease and cardiovascular events. However, no RCTs have demonstrated such a benefit. 