Given that most patients with CKD die from CVD complica- tions, this RCT evidence supports a lower target of <130/80 mm Hg for all patients with CKD (Figure 6). It is appro- priate to acknowledge that many patients with CKD have additional comorbidities and evidence of frailty that caused them to be excluded from past clinical trials. Observational studies of CKD cohorts indicate a higher risk of mortality at lower systolic pressures and a flat relationship of SBP to event risk in elderly patients with CKD,S9.3-29,S9.3-30 which sup- ports concerns that these complex patients may be at greater risk of complications from intensive BP treatment and may fail to achieve benefits from lower BP targets. In contrast, in the prespecified subgroup analysis of the elderly cohort in SPRINT, frail elderly patients did sustain benefit from the lower BP target, which supports a lower goal for all patients, including those with CKD.S9.3-31 In this setting, incremental BP reduction may be appropriate, with careful monitoring of physical and kidney function. An ACE inhibitor (or an ARB, in case of ACE inhibitor intolerance) is a preferred drug for treatment of hyperten- sion if albuminuria ( 300 mg/day or 300 mg/g creatinine by first morning void) is present, although the evidence is (Figure 6). 