In addition to the differences in the prevalence of types of kidney diseases in different groups, there appear to be differences in the rates of CKD progression, in the effects of BP control on CKD progression, in BP responses to various antihypertensive regimens, and in cardiovascular risk asso- ciated with a particular BP level. Outlining this evidence is beyond the scope of this Guideline, but clearly the scientific community is currently only scratching the surface of the links among BP, CKD, race, ethnicity, genes, and epigenetics. In the future evidence may become available regarding how to modify BP control in CKD according to an individual s genetic profile, or ethnic or racial background. In the meantime, we must pay greater attention to socioeconomic and environmental issues related to ethnicity or race, which are more immediately amenable to modification. 8.7: BARRIERS TO IMPLEMENTATION Although several guidelines on BP management in CKD have been published, BP management in CKD patients is often suboptimal and audit studies suggest that the target readings are not achieved in many patients.441 The reasons why it is challenging to implement recommendations and to achieve target BP in CKD (and other) patient populations are multiple and complex, but are likely to include the issues listed below. Because of these uncertainties we cannot suggest that the recommended BP targets in this Guideline should be used as performance measures in the management of CKD patients. The credibility of the guideline is questioned. Not all clinicians agree with the currently recommended BP targets, at least not for all of their patients. 