They demonstrated a reduction in the rates of all-cause mortality and stroke in the low-BP active-treatment group over a median 1.8 years of follow-up. Patients were withdrawn if systolic BP fell to o110 mm Hg. However, exclusion criteria included secondary hypertension (which might be of kidney origin) and a SCr level 41.7 mg/ dl (4150 mmol/l) (which represents a GFR of 39 or 37 ml/ for an 80-year-old white man, as estimated by either the MDRD or CKD Epidemiology Collaboration (CKD-EPI) equation, respectively and a GFR of 29 or for an 80-year-old white woman as esti- mated by the MDRD and CKD-EPI equations, respectively). The mean baseline creatinine levels were 88.6 mmol/l (1.0 mg/ dl) and 89.2 mmol/L (1.0 mg/dl) in the active-treatment and placebo groups, respectively which were well below the exclusion level. Accordingly, direct extrapolation of these data to patients with known advanced CKD is not possible. Although this evidence provides some reassurance regard- ing treatment of high BP in the very elderly, it only does so with respect to treatment to a BP target level of 150/80 mm Hg, and it does not specifically address CKD for men and women, respectively. Very importantly, however, the evidence challenges any tendency toward therapeutic nihilism in the very elderly with high BP and CKD 1 3. 