All previous studies in diabetes with and without CKD have favored more, instead of less, intensive BP reduction ). In their meta-analysis, Ettehad et al. reported that the reduction in major CV events remained proportional to the BP reduc- tion achieved among trial participants with diabetes, but that the proportional risk reductions were smaller than the re- ductions in those without diabetes.105 In contrast, in the meta-analysis of intensive versus less-intensive BP-lowering therapy among patients with CKD, Malhotra et al. found no evidence of heterogeneity in bene cial effects on mortality with respect to the presence or absence of diabetes.111 Brunstr m et al. conducted a systematic review and meta- analysis of RCTs that included at least 100 patients with diabetes, and found that BP reduction decreased MI, stroke, CV mortality, ESKD, and all-cause mortality if baseline SBP was >150 mm Hg; there was decreased MI, HF, and all-cause mortality if baseline SBP was 140 to 150 mm Hg, but para- doxically, increased CV mortality was observed if baseline SBP was <140 mm Hg.118 Two major caveats should be noted regarding these meta- analyses in diabetes. First, these meta-analyses differ sub- stantially from each other in their respective inclusion criteria. Brunstr m et al. and Ettehad et al. included RCTs that compared antihypertensives to placebo, and different BP targets. Ettehad et al. included RCTs of head-to-head com- parisons of antihypertensive agents to examine the effect of 10 mm Hg reduction in SBP on clinical outcomes. Second, none of the trials conducted prior to ACCORD and SPRINT examined an SBP target as low as <120 mm Hg. Nonetheless, they collectively suggest that SBP lowering decreases the CV event rate and perhaps mortality and kidney outcomes. 