Referral to a hypertension specialist may be indicated for patients in whomgoalBPcannotbeattainedusingtheabovestrategyorfortheman- agement of complicated patients for whom additional clinical consulta- tion is needed. (Expert Opinion Grade E) 2014 Guideline for Management of High Blood Pressure Special Communication Clinical Review & Education jama.com JAMA Published online December 18, 2013 E5 Recommendation 3 is based on expert opinion. While there is high-quality evidence to support a specific SBP threshold and goal found insufficient evidence from good- or fair-quality RCTs to sup- port a specific SBP threshold or goal for persons younger than 60 years. In the absence of such evidence, the panel recommends an SBP treatment threshold of 140 mm Hg or higher and an SBP treat- ment goal of lower than 140 mm Hg based on several factors. First,intheabsenceofanyRCTsthatcomparedthecurrentSBP age group, there was no compelling reason to change current rec- ommendations.Second,intheDBPtrialsthatdemonstratedtheben- to have achieved SBPs of lower than 140 mm Hg with treatment. It isnotpossibletodeterminewhethertheoutcomebenefitsinthese trials were due to lowering DBP, SBP, or both. Third, given the rec- ommended SBP goal of lower than 140 mm Hg in adults with dia- general population younger than 60 years may facilitate guideline implementation. In the population aged 18 years or older with CKD, initiate pharma- of 90 mm Hg or higher and treat to goal SBP of lower than 140 mm Hg and goal DBP lower than 90 mm Hg. Expert Opinion Grade E Based on the inclusion criteria used in the RCTs reviewed by the panel, this recommendation applies to individuals younger than 70 years with an estimated GFR or measured GFR less than and in people of any age with albuminuria defined as greater than 30 mg of albumin/g of creatinine at any level of GFR. question 2. 