diabetic kidney disease.Duration of diabetes, in years,is presented on the horizontal axis. Timeline is well characterized for type 1 diabetes mellitus; for type 2 diabetes mellitus, timeline may depart from the illustration due to the variable timing of the onset of hyperglycemia. *Kidney complications: anemia, bone and mineral metabolism, retinopathy, and neuropathy. Clin J Am Soc Nephrol 12: 2032–2045, December, 2017 Diabetic Kidney Disease, Alicic et al. 2037 (19,22). However, intensive glucose control after onset of complications or in longstanding diabetes has not been shown to reduce risk of DKD progression or improve overall clinical outcomes. Targeting low HbA1C (6%–6.9%) compared with standard therapy in this population did not reduce risk of cardiovascular (CV) or microvascular complications but increased the risk of severe hypoglycemia (54–56). Furthermore, an analysis of patients with DM2 and early-stage CKD showed 30% and 40% higher risks for allcause mortality and CV mortality, respectively, with intensive glycemic control compared with standard therapy (57). The finding that intensive glycemic control incurs great risk of hypoglycemia and does not benefit the risk of CVD or all-cause mortality has been sustained over the long term (8–10 years). A small benefit of intensive glycemic control on the risk of ESRD was observed, but the absolute number of patients was minute (58). A stratified analysis showed that the greatest benefit of intensive glycemic control for preventing ESRD was seen in participants without kidney disease at study entry, further supporting the concept that intensive glycemic control initiated during early diabetes can prevent DKD (59). The American Diabetes Association recommends that targets for glycemia should be tailored to age, comorbidities, and life expectancy of individual patients. More stringent goals, such as HbA1C,6.5%, may be reasonable for patients with shorter duration of diabetes, younger age, absence of complications, and a longer life expectancy. To the contrary, less stringent goals of HbA1C,8% are recommended for patients with longstanding diabetes, older age, micro- and macrovascular complications, and limited life expectancy (51). Similarly, the National Kidney Foundation–Kidney Disease Outcomes Quality Initiative and the Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend a target HbA1c of about 7.0% to prevent or delay progression of the microvascular complications of diabetes. However, patients at risk for hypoglycemia, such as those with diabetes and CKD, should not be treated to an HbA1c target of ,7.0% (53). For management of hypertension, the Eighth Joint National Committee (JNC-8) recommended initiation of pharmacologic treatment at a systolic BP $140 mmHg or diastolic BP $90 mmHg, with treatment goals less than these levels. In the general hypertensive population, including those with diabetes, initial antihypertensive treatment may include a thiazide-type diuretic, a calcium channel blocker, an angiotensin-converting enzyme (ACE) inhibitor, or an angiotensin receptor blocker (ARB). In black patients with diabetes, the JNC-8 recommends initial treatment with a thiazide diuretic or calcium channel blocker. The same BP targets are recommended for those with CKD irrespective of diabetes status. In patients who are diabetic with high levels of albuminuria, the medication regimen should include an ACE inhibitor or an ARB alone or in combination with medication from another drug class (60). The KDIGO guidelines recommend use of an ACE or an ARB and a BP goal ,130/80 mmHg in all patients with CKD and albuminuria irrespective of diabetes status (52). There is unambiguous evidence that renin-angiotensin system blockade with either an ACE inhibitor or an ARB reduces the progression of DKD in patients with macroalbuminuria (61). However, combination therapy (an ACE inhibitor and an ARB administered together) increases the risk of serious side effects, primarily hyperkalemia and AKI, and offers no clinical benefits (62,63). Following the liberalized JNC-8 recommendations, target BP goals have been challenged by results of the Systolic BP Intervention Trial (SPRINT). The SPRINT included 9361 nondiabetic participants with hypertension and high CV risk. Participants were randomized to either an intensive (,120 mmHg) or standard (,140 mmHg) systolic BP goal. The trial was terminated early after a median of 3.26 years, because rates of the primary outcome (myocardial infarction, acute coronary syndrome, stroke, heart failure, or death from CV causes) and all-cause mortality were reduced by 25% and 27%, respectively, in the intensively treated group compared with the standard regimen group. These results held across prespecified subgroups defined according to CKD stage, age .75 years old, sex, race, previous CVD, and baseline levels of systolic BP (64,65). In contrast to the SPRINT, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial, which included 4733 patients with diabetes at high risk for CV events, showed that achieving the same systolic BP targets (,120 versus ,140 mmHg) did not have a statistically significant effect on the risk of nonfatal myocardial infarction, nonfatal stroke, death from CV cause, or death from any causes (66). One of the possible explanations for this