In addition, there is evidence that the classic histological features of diabetic nephropathy can on occasion be found in patients who do not have a high urine Also, progressive loss of excretory kidney function has been observed in the absence of progression from microalbuminuria to overt proteinuria in some patients Observational studies in the general population provide strong evidence of a linear relationship between BP and risk of cardiovascular events.21 A large number of RCTs have also shown that drugs that reduce BP also reduce the risk of subsequent cardiovascular events.198 The benefits of BP reduction observed in clinical trials involving high-risk patients have also been shown to be consistent across a range of baseline BP levels in recent, large meta-ana- In addition, baseline BP levels have been shown to be a powerful determinant of the subsequent risk of kidney failure in large population-based studies from around the Diabetes increases the risk of CVD by a factor of two to three at every level of systolic BP,201 and this risk is further potentiated by the presence of CKD. In addition, type 2 diabetes is a leading cause of CKD, accounting for 30 to 50% of new cases of kidney failure in the industrialized world.202 Microalbuminuria is one of the earliest detectable manifesta- tions of kidney disease in patients with diabetes, with a prevalence of 25% after 10 years of diabetes and an annual rate of progression to overt nephropathy of approximately The risk of incident and progressive microalbumin- uria is highly associated with BP levels.204 Progression of retinopathy is also closely associated with high BP.205 208 It is therefore important that the clinician is provided with clear, evidence-based recommendations on the use of BP-lowering drugs in the management of patients with diabetes and CKD. 