A philosophy of patient-centered care (rather than disease-directed care) is particularly relevant as the elderly become very elderly.385 The high likelihood of elderly patients developing cardiac and cerebrovascular complications in the context of a high BP, along with evidence that kidney function may decline more slowly in the elderly than in younger patients (particularly when the GFR should lead to a greater emphasis on vascular rather than kidney outcomes. More- over, particularly in the very elderly, possible beneficial effects of therapy on morbidity and mortality should be balanced against any negative effects on quality of life.388 BP TARGETS IN THE ELDERLY Although there have been many studies of treatment of high BP in the elderly, there is little evidence specific to the elderly with known CKD. Most relevant information comes from observational studies and RCTs involving entire populations of older hypertensive patients not specifically chosen on the basis of kidney function (Supplementary Table 66 online). Renal failure or a designated upper limit for the SCr concentration have been an exclusion criterion in many studies, reducing the applicability of the data to CKD patients. A meta-analysis of observational studies conducted prior to 2002, including nearly 1 million subjects selected for having no previously known vascular disease, indicated that the rates of stroke, ischemic heart disease, and overall mortality increased with increasing BP, even among subjects 60 to 89 years of age, although the RR decreased with increasing age.21 RCTs involving elderly patients not selected for having CKD indicate that it is beneficial to treat high BP in patients 460 years of age. 