However, this lower SBP goal is not supported by any RCT that randomized participants into 2 or more groups in which Clinical Review & Education Special Communication 2014 Guideline for Management of High Blood Pressure E6 JAMA Published online December 18, 2013 jama.com treatment was initiated at a lower SBP threshold than 140 mm Hg or into treatment groups in which the SBP goal was lower than 140 mmHgandthatassessedtheeffectsofalowerSBPthresholdorgoal onimportanthealthoutcomes.TheonlyRCTthatcomparedanSBP treatment goal of lower than 140 mm Hg with a lower SBP goal and assessed the effects on important health outcomes is ACCORD-BP, which compared an SBP treatment goal of lower than 120 mm Hg with a goal lower than 140 mm Hg.7 There was no difference in the primary outcome, a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke. There were also no dif- ferences in any of the secondary outcomes except for a reduction in stroke. However, the incidence of stroke in the group treated to lower than 140 mm Hg was much lower than expected, so the ab- solute difference in fatal and nonfatal stroke between the 2 groups was only 0.21% per year. The panel concluded that the results from ACCORD-BP did not provide sufficient evidence to recommend an SBP goal of lower than 120 mm Hg in adults with diabetes and hy- pertension. The panel similarly recommends the same goal DBP in adults with diabetes and hypertension as in the general population (<90 mm Hg). Despite some existing recommendations that adults with diabetesandhypertensionshouldbetreatedtoaDBPgoaloflower than 80 mm Hg, the panel did not find sufficient evidence to sup- port such a recommendation. For example, there are no good- or fair-qualityRCTswithmortalityasaprimaryorsecondaryprespeci- fied outcome that compared a DBP goal of lower than 90 mm Hg with a lower goal (evidence statement 21). 