Expert Opinion Grade E Syst-Eur, and UKPDS) that treatment to an SBP goal of lower than in adults with diabetes and hypertension.23-25 No RCTs addressed whether treatment to an SBP goal of lower than 140 mm Hg com- outcomesinadultswithdiabetesandhypertension.Intheabsence of such evidence, the panel recommends an SBP goal of lower than based on expert opinion, consistent with the BP goals in recom- hypertension.UseofaconsistentBPgoalinthegeneralpopulation younger than 60 years and in adults with diabetes of any age may facilitateguidelineimplementation.ThisrecommendationforanSBP goal of lower than 140 mm Hg in patients with diabetes is also sup- portedbytheACCORD-BPtrial,inwhichthecontrolgroupusedthis goal and had similar outcomes compared with a lower goal.7 The panel recognizes that the ADVANCE trial tested the ef- fects of treatment to lower BP on major macrovascular and micro- vascular events in adults with diabetes who were at increased risk of CVD, but the study did not meet the panel s inclusion criteria be- causeparticipantswereeligibleirrespectiveofbaselineBP,andthere were no randomized BP treatment thresholds or goals.26 The panel also recognizes that an SBP goal of lower than 130 mmHgiscommonlyrecommendedforadultswithdiabetesandhy- pertension. 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. 