RCTs have demonstrated a benefit from antihypertensive therapy in patients with a diastolic BP .90 mm Hg547 and also in patients with isolated systolic hypertension and a systolic BP .160 mm Hg.539,551,552 The Seventh Report of the Joint National Committee on Prevention, Detection, Evalua- tion, and Treatment of High Blood Pressure recommends a target BP of ,140/90 mm Hg in patients with uncomplicated hypertension and of ,130/80 mm Hg in patients with diabetes mellitus or CKD.17 Observations from epidemiolog- ical studies and the relatively high absolute risk of cardiovas- cular events in patients with vascular disease have led some to suggest that a lower BP target might also be appropriate in individuals with SIHD.553 On the other hand, excessive reduction in diastolic BP could compromise coronary perfusion in SIHD patients, and some studies have demonstrated a J-shaped relationship between diastolic BP and coronary events.554 The ACCORD (Action to Control Cardiovascular Risk in Diabetes) BP trial,555 which enrolled patients with type 2 diabetes mellitus at high risk of cardiovascular events, found no benefit of targeting a systolic BP of 120 mm Hg compared with a systolic BP of 140 mm Hg in reducing a composite endpoint of MI, stroke, or death from cardiovascular causes. In a related vein, in AASK (African-American Study of Kidney Diseases and Hypertension),556 1094 black patients with hypertensive kidney disease (diastolic pressure .95 mm Hg and glomerular filtration rate of 20 to 60 mL/min) and no diabetes mellitus were randomly assigned to achieve a mean arterial pressure target #92 mm Hg (corresponding to 130/ 80 mm Hg) or to a target of 102 to 107 mm Hg (correspond- ing to 140/90 mm Hg). 