In subsequent stratified analyses, the effects were more pronounced in children with glomerulopathy and kidney hypodysplasia or dysplasia. There was no evidence of improved outcomes in individuals with hereditary nephropathies or other congenital causes of kidney disease other than aplasia or dysplasia, although there were relatively few individuals in these subgroups. Additionally, in stratified analyses, the efficacy of the intensified BP control intervention was most marked in children with a urine PCR of 4150 mg/g (415 mg/mmol) (see supplement of Wuhl ). Data presented at the American Society of Nephrology 2010 annual meeting from the observational CKiD study336 also shows slower progression of decline in kidney function in individuals with auscultatory manual BP below the 50th percentile for age, sex, and height as compared to individuals with BP between the 50th percentile and those with BP above the 90th percentile. BP in this study is measured according to a standard protocol at annual study visits with an aneroid device. BP targets in children with CKD should be individualized on the basis of susceptibility to hypotension. Many causes of childhood CKD include diagnoses associated with salt and water losses in the urine. As such, the risk of hypotension associated with aggressive BP control should temper the ramping-up of BP-lowering medication to reach a low BP target. 6.3: We suggest that an ARB or ACE-I be used in children with CKD ND in whom treatment with BP-lowering drugs is indicated, irrespective of the level of RATIONALE This recommendation is based on published experience with these agents in children with hypertension, showing the drugs to be safe and effective in lowering BP and to confer a benefit for slowing CKD and reducing urine protein levels in adults with CKD. 