This study tested the hypothesis that among ACCORD participants with established type 2 diabetes, randomization to intensive (SBP < 130 mm Hg) versus standard (SBP 130-139 mm Hg) blood pressure (BP) control is related to significant improvement in health related quality of life (HRQL). All ACCORD Blood Pressure HRQL sub-study participants who completed the baseline plus at least one of the 12, 36 or 48 month HRQL evaluations were included in this analysis. We used multivariate regression analysis to assess whether ACCORD BP treatment assignment (intensive versus standard BP control) was signifi cantly related to baseline HRQL, or to change in HRQL from baseline to longest available follow-up time. Among 1,028 eligible participants with analyzable data, we found no baseline differences in measures of HRQL between those in the intensive and standard BP treatment groups. At follow-up, 5 of 6 HRQL measures were no different between groups, but those assigned to intensive BP versus standard BP control had significantly worse SF36 Physical Component Scores (-0.8 versus -0.2; p=0.0195), with no variation across pre-specified patient subgroups. Intensive control of BP in adults with type 2 diabetes did not affect, either positively or negatively, most pre-specified measures of HRQL. However, those randomized to intensive BP treatment had significantly worse physical function at the end of the trial. Further work is needed to elucidate the mechanism of this unexpected finding.