Participants Briefly, between November 2010 and March 2013, participants 50 years of age or older with treated or untreated SBP of 130–180 mm Hg and at least one of the following indicators of increased cardiovascular risk were enrolled: evidence of clinical or subclinical cardiovascular disease, CKD defined as an eGFR of 20 to ,60 ml/min per 1.73 m2 using the fourvariable Modification of Diet in Renal Disease equation, a 10- year Framingham risk score for cardiovascular events $15%, or age 75 years old or older. Persons with a history of stroke, diabetes mellitus, polycystic kidney disease, dementia, heart Table 1. Baseline characteristics by tertile of baseline diastolic BP among the Systolic Blood Pressure Intervention Trial participants with baseline CKD (N52646) Baseline Characteristic Lowest tertile ,69 mm Hg, N5823 Middle tertile 569–79 mm Hg, N5893 Highest tertile $80 mm Hg, N5930 Diastolic BP, mm Hg 6166 7463 8867 Age, yr 76.168.0 72.468.4 67.769.2 Women, % 42.0 40.8 37.4 Black race, % 19.9 21.7 30.8 Cardiovascular disease, % 30.7 26.5 16.6 Framingham 10-yr cardiovascular disease risk score $15%, % 63.5 64.6 65.4 Never smoked, % 44.2 45.4 47.1 Antihypertensive agents, no. per patient 2.360.9 2.161.0 1.961.0 Systolic BP, mm Hg 133616 137614 147615 Pulse pressure, mm Hg 71616 63613 59614 Body mass index, kg/m2 28.565.6 29.365.6 30.465.9 eGFR, ml/min per 1.73 m2 47610 4869 4969 CKD stage 3b or higher (eGFR,45 ml/min per 1.73 m2 ), % 39.2 32.8 29.5 Urine albumin-creatinine ratio, mg/g 13.3 (6.8–38.8) 11.6 (5.8–36.4) 15.1 (6.7–52.8) Results are presented as percentage for binary variables and as mean 6 SDs for continuous variables other than albumin-creatinine ratio, which is presented as median (interquartile range). For comparison of differences between the tertiles for numeric variables by using one-way ANOVA and categorical variables by using chi-squared tests, all P values were , 0.001, except for women (P50.12), Framingham 10-year cardiovascular disease risk score $15% (P50.72), and never smoked (P50.48). Standard Intensive 160 140 120 Mean follow-up SBP (mmHg) 100 < 69 69 - 79 ≥ 80 A 100 80 60 Mean follow-up DBP (mmHg) 40 Baseline DBP tertiles (mmHg) Baseline DBP tertiles (mmHg) < 69 69 - 79 ≥ 80 B Figure 1. | Achieved mean SBP was similar across tertiles of baseline DBP, while achieved mean DBP was lower among participants in the lowest tertile of baseline DBP comred with the highest tertile. Follow-up minimum, median, 25th and 75th percentiles and maximum of patients’ mean follow-up systolic BP (SBP; A) and diastoic BP (DBP; B) by randized SBP intervention and tertile of baseline DBP. Note that 75 of 2646 subjects (2.8%; 47 in the standard group and 28 in the intensive group) had missing BP measurements after month 2 and were excluded. KIDNEY360 1: 368–375, May, 2020 Diastolic Blood Pressure in SPRINT CKD, Chang et al. 369 failure, nonadherence to medication, eGFR,20 ml/min per 1.73 m2, or $1 g of proteinuria per day (or the equivalent) were not eligible for participation. Participants enrolled were randomized to an intensive office SBP target of ,120 mm Hg or a standard office SBP target of ,140 mm Hg. This analysis includes the 2646 participants with baseline CKD defined as eGFR,60 ml/min per 1.73 m2. All participants provided written informed consent for participation in the trial. The study was adherent to the Declaration of Helsinki. The trial was approved by an institutional review board at each site, and it was registered in ClinicalTrials.gov (NCT01206062). BP Measurement BP was estimated as the mean of three readings obtained at 1-minute intervals using standardized measurement techniques. Each BP reading was obtained using an automated machine (Model 907; Omron Healthcare) after the patient had been seated quietly for 5 minutes during a study office visit. During a 5-minute rest period prior to the BP measurements and during the measurements, study participants were either alone or with a member of the study team. Similar achieved BP levels and cardiovascular risk reduction were observed regardless of whether BP was measured with or without a staff member present (11). Covariates Trained study personnel ascertained information about participant baseline sociodemographic data, comorbid conditions, and antihypertensive medications during the screening or randomization visit. Fasting blood and urine samples were also collected. All assays were performed in a single central laboratory. Serum creatinine and urine creatinine were measured using an enzymatic procedure (Roche, Indianapolis, IN). Urine albumin was measured using a nephelometric method (Siemens, Tarrytown, NY). Outcomes The primary composite end point in SPRINT and in this analysis was the first occurrence of a myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure, or a cardiovascular death. We also examined all-cause death. The primary composite end point and death from any cause were adjudicated by a committee blinded to the treatment group assignments. Adverse events were monitored throughout the trial (9). In this analysis, we examined any serious adverse event and serious adverse events associated with hypotension, syncope, electrolyte abnormalities, and AKI or