Thus BP targets in the elderly, with or without CKD, should be set only after consideration of co-morbidities and should be achieved gradually. Based on the evidence on BP in the elderly (not selected for CKD), recent guidelines and consensus documents generally agree that o140/90 mm Hg should be the target in uncomplicated hypertension.117,395,396 The American College of Cardiology Foundation and American Heart Association (ACCF/AHA), in collaboration with a large group of other American and European bodies, acknowledge in their consensus document on hypertension in the elderly that although there is limited information for evidence-based guidelines to manage older hypertensive patients, a target of o140/90 mm Hg is recommended in uncomplicated hypertension for the age range 65 79 years.395 This document acknowledges that the target for 480 years is unclear, and refers to expert opinion and observational data (including KDOQI 2002 and JNC 7) suggesting o130/ 80 mm Hg as a target in CKD, irrespective of albuminuria. From the UK, NICE has published a comprehensive guideline for management of hypertension in adults which also recommends BP o140/90 mm Hg for primary hyperten- sion up to 80 years of age, and for those over 80 years who are Caution is recommended when starting BP medications in those over 80 years of age, and no recommendation is given with respect to the elderly with CKD. Although intuitively there must be a lower limit for safe BP control in the elderly and very elderly, there will probably never be an RCT designed specifically to address this limit in these populations. 