The optimum survival was associated with the ranges of diastolic BP between 70 79mm Hg and systolic BP between 130- In another smaller study (n 331) of mortality with 2 year follow-up in elderly hospitalized subjects 470 years with vascular disease or hypertension, the longest survival was observed when diastolic BP was in the range 71 80mm Hg, with a pronounced increase in risk with diastolic BP r60mmHg.410 Further evidence to discourage aggressive reduction in BP in high risk groups comes from secondary analyses of outcomes associated with achieved BPs in the context of large RCTs. Such analyses are retrospective in nature and the trials themselves have not specifically recruited (and often excluded) patients with reduced GFR, so they cannot be used to formulate a guideline for a lower BP target in the context of CKD. One example of such a study is a retrospective analysis of the active treatment group of the SHEP trial. In this study, 4736 subjects aged Z60 years with a systolic BP 4160mmHg and diastolic o90mmHg were randomized to placebo or BP reduction with chlorthalidone with or without atenolol to reduce systolic BP. Perhaps surprisingly, a low diastolic BP on treatment was associated with an increased risk of stroke, coronary heart disease and CVD.41 Likewise in INVEST, a multi-national RCT comparing verapamil sustained-release and atenolol-based treatment in 22,576 patients with hypertension and CAD, BP control and outcomes were equivalent between the groups, but the risk of the primary outcome (all-cause death, non-fatal myocardial infarction and non-fatal stroke) progressively increased with a BP lower than 119/84mmHg, although taken alone, stroke risk did not increase with lower BP. 