Most interpretations of the observational evidence predict that achieved BPs below a target of r140/ 90 mm Hg in patients with CKD and diabetes would be associated with additional benefit in the prevention of both progressive kidney disease and cardiovascular events. However, no RCTs have demonstrated such a benefit. It remains possible that clinical harm could be done, at least in some subgroups, by attempting to reach lower BPs. Achieving lower BPs would require multiple drug treatments in the majority of patients with CKD and diabetes, particularly those with high pulse pressures. This has implications both for adherence and for the cost of treatment, of which the latter is particularly important in resource-poor settings. 4.2: We suggest that adults with diabetes and CKD ND with urine albumin excretion 430 mg per 24 hours (or equivalent*) whose office BP is consistently 4130 mm Hg systolic or 480 mm Hg diastolic be treated with BP-lowering drugs to maintain a BP that is consistently r130 mm Hg systolic and r80 mm Hg diastolic. (2D) *Approximate equivalents for albumin excretion rate per 24 hours expressed as protein excretion rate per 24 hours, albumin/creatinine ratio, protein/creatinine ratio, and protein reagent strip results are given in Table 1, Chapter 1. RATIONALE K Observational studies show that the level of urine albumin predicts the risk of adverse cardiovascular and kidney outcomes. K BP lowering reduces the rate of urinary albumin excretion, which may in turn lead to a reduced risk of both kidney and cardiovascular events, although this has not been shown in RCTs. RCTs. 