What
is
of
major
importance
is
that
in
both
theACCORD-BP and the relevant meta-analyses, even with theabove
limitations,
RRs
of
all
outcomes
studied
pointedstrongly toward benefit with the ‘intensive’ target; thus, thepossibility that higher power could have led to significantdifferences
in
favor of
the
‘intensive’ targets
cannot
beexcluded. Overall, based on all available data, the DBP targetof o80 mmHg seems justified for all patients with diabetes(Tables 1 and 2) for reasons of reduction in cardiovascularend points and mortality. On the other hand, the criticalquestion of whether the o130 mmHg SBP target in patientswith diabetes is justified remains unanswered. This could beconclusively
answered
by
an
adequately
powered
trialcomparing o130 with o140 mmHg SBP goals and ensuringrelevance of achieved BP to target BP levels. Until suchevidence
appears,
caution
in
data
interpretation
andindividualization of treatment seems the best way forward.For patients with CKD, this has been exemplified by reportsnoting
that
in
all
major
renal
outcome
studies,
theproportion of participants 470 years old was particularlysmall, and such evidence is of little relevance to the elderlydiabetics, which is the faster growing patient group.39 Whenit comes to BP target, a level of o125/75 mmHg may beeasily
tolerated
and
confer
nephroprotection
in
youngindividuals; however, the same level in the elderly diabeticscould be associated with frequent episodes of hypotensionand
acute
renal
failure
(especially
with
concomitantaggressive RAAS blockade or diuretic use, and presence ofatherosclerotic renal artery lesions), leading to loss of renalfunction much faster than anticipated.40