What evidence is there to suggest that intensive SBP lowering is beneficial for patients with diabetes and CKD?
Although the ACCORD trial enrolled exclusively patients with diabetes, it included few patients with CKD, as patients with serum creatinine >1.5 mg/dl (132 mmol/l) were excluded. Nonetheless, there was no statistical interaction between CKD and intensive BP lowering on the reduction in stroke risk. The SPRINT trial included a substantial number (n 2646) of participants with CKD, although it excluded patients with diabetes. A post hoc analysis of SPRINT comparing participants with and without prediabetes found that the CV and survival benefits of intensive SBP reduction (<120 mm Hg) were similar in the two subgroups. Additionally, a combined post hoc analysis of SPRINT and ACCORD suggested similar CV benefits of intensive BP-lowering therapy in the presence or absence of diabetes. These findings suggest there is evidence to support the benefits of intensive SBP lowering for patients with diabetes and CKD. 