Several meta-analyses and systematic reviews support more intensive BP treatment to reduce cardiovascular events but do not demonstrate a reduction in the rate of progression of kidney More intensive BP treat- ment may result in a modest reduction in glomeru- lar filtration rate, which is thought to be primarily attributable to a hemodynamic effect and may be reversible. Electrolyte abnormalities are also more likely during intensive BP treatment. 5. Most adults with diabetes mellitus a 10-year ASCVD risk 10%, requiring initiation of antihy- pertensive drug therapy at BP 130/80 mm Hg and a treatment goal of <130/80 mm Hg.S4.4-73 Several meta-analyses of RCTs included all trials with a difference in BP levelsS4.4-31,S4.4-71 and sup- ported lowering BP to <130/80 mm Hg among those with diabetes mellitus. Two meta-analyses addressing target BP in adults with diabetes mel- litus restricted the analysis to RCTs that random- ized patients to different BP levels.S4.4-33,S4.4-47 Target BP of 133/76 mm Hg provided significant benefit compared with that of 140/81 mm Hg for major cardiovascular events, MI, stroke, albuminuria, and retinopathy progression.S4.4-33 In the ACCORD (Action to Control Cardio vascular Risk in Diabetes) trial,S4.4-51 lowering the BP target (SBP <120 mm Hg) did not reduce the rate of the composite outcome of fatal and non- fatal major cardiovascular events and was asso- ciated with greater risk of adverse events, such as self-reported hypotension and a reduction in estimated glomerular filtration rate. Secondary analyses of the ACCORD trial demonstrated a sig- nificant outcome benefit of stroke risk reduction in the intensive BP/standard glycemic group.S4.4-74 6. 