In a diabetic cohort of subjects with hypertension and CAD in INVEST,116 tight control of SBP (<130 mmHg) was not associated with Rosendorff et al Treatment of Hypertension in Patients With CAD 1385 improved cardiovascular outcomes compared with usual con- trol (130 139 mmHg), although in an extended follow-up of 9 years, the risk of all-cause mortality was 22.8% versus 21.8%, respectively, which was just statistically significant. This is a small difference, and it is uncertain whether this can be regarded as a contribution to clinical decision making. In the earlierAppropriate Blood Pressure Control in Diabetes (ABCD) trial, the mean BP achieved was 132/78 mmHg in the intensive group and 138/86 mmHg in the moderate BP con- trol group. After 5 years, there was no difference between the groups in the progression of diabetic microvascular complica- tions or in the rate of MI, stroke or HF. However, unlike the result in INVEST, theABCD participants in the intensive group had a significant reduction in all-cause mortality.153 The latest standards of medical care in diabetes mellitus of the American Diabetes Association recommend a goal BP of <140/80 mmHg; lower values, <130/80 mmHg, may be appropriate for certain individuals, such as younger patients, if it can be achieved without undue treatment burden. 3.2.5. Lower BP Goals for the Prevention of Stroke Patients with atherosclerotic stroke should be included among those deemed to be at high risk ( 20% over 10 years) of fur- ther atherosclerotic cardiovascular events.154 Besides ACCORD, in which there was no excess MI from intensive BP lowering and some benefit in preventing stroke, there have been other studies in which the effects of BP lower- ing on stroke outcomes have been documented. With 1 excep- tion, the reports are consistent with supporting better stroke outcomes with BPs <130/80 mmHg. 