Although treat- ment with an ACEI or ARB may be beneficial in those older than 75 years, use of a thiazide-type diuretic or CCB is also an option for in- dividuals with CKD in this age group. Use of an ACEI or an ARB will commonly increase serum creati- nine and may produce other metabolic effects such as hyperkale- mia, particularly in patients with decreased kidney function. Al- thoughanincreaseincreatinineorpotassiumleveldoesnotalways require adjusting medication, use of renin-angiotensin system in- hibitorsintheCKDpopulationrequiresmonitoringofelectrolyteand serum creatinine levels, and in some cases, may require reduction in dose or discontinuation for safety reasons. The main objective of hypertension treatment is to attain and maintain goal BP. If goal BP is not reached within a month of treat- ment, increase the dose of the initial drug or add a second drug from one of the classes in recommendation 6 (thiazide-type diuretic, CCB, ACEI, or ARB). The clinician should continue to assess BP and adjust the treatment regimen until goal BP is reached. If goal BP cannot be reached with 2 drugs, add and titrate a third drug from the list provided. Do not use an ACEI and an ARB together in the same patient. If goal BP cannot be reached using the drugs in recommendation 6 because of a contraindica- tion or the need to use more than 3 drugs to reach goal BP, anti- hypertensive drugs from other classes can be used. Referral to a hypertension specialist may be indicated for patients in whom goal BP cannot be attained using the above strategy or for the management of complicated patients for whom additional clinical consultation is needed. Expert Opinion Grade E a perceived need for further guidance to assist in implementation of recommendations 1 through 8. 