Tight BP control confers no additional benefit with respect to cardiovascular outcomes in patients with diabetes and CAD compared with usual control, a major trial has shown. It may actually worsen outcomes in the long-term. The INVEST study randomly assigned 22,576 patients to two BP lowering regimens starting with verapamil SR or atenolol and adding in an ACEI, thiazide diuretic or both. The main trial results were published in 2003 and showed no difference in cardiac outcomes between the two approaches. This recently published post hoc analysis of the original data categorised 6,400 diabetes patients with established CAD according to the degree of BP control actually achieved. The primary endpoint was a composite of death, MI or stroke. 'The authors conclude that aiming for a systolic BP lower than 130mmHg has no advantages over usual care and indeed could be harmful over the long term in this patient population. Although this was essentially a subgroup analysis the findings are in keeping with other trials such as ACCORD and should prompt us to exercise caution in lowering BP too aggressively in diabetes patients with CAD.'