3.3: We suggest that non-diabetic adults with CKD ND and urine albumin excretion 4300 mg per 24 hours (or equivalent*) whose office BP is consistently 4130 mm Hg systolic or 480 mm Hg diastolic be treated with BP-lowering drugs to maintain a BP that is consistently r130 mm Hg systolic and r80 mm Hg diastolic. (2C) *Approximate equivalents for albumin excretion rate per 24 hours expressed as protein excretion rate per 24 hours, albumin/creatinine ratio, protein/creatinine ratio, and protein reagent strip results are given in Table 1, Chapter 1. RATIONALE K Albuminuria is a major risk factor for CVD and CKD progression. K RCTs show that BP r130/80 mm Hg may reduce progression of CKD in patients with urine albumin excretion 4300 mg per 24 hours ( macroalbuminuria ). Patients with macroalbuminuria are at very high risk for both progression of CKD and development of CVD.18,162,163 Observational data suggest that hypertension is a risk factor for CVD and progression of CKD in patients with macro- As noted above, short-term follow-up data from the MDRD study142 showed an interaction of BP target with the level of urine protein, with a definitive benefit in patients with a urine protein level 41 g per 24 hours (in Study A) and a trend toward a benefit with lower protein levels; long-term follow-up data showed a benefit of a lower target BP. In subgroup analyses, a benefit was noted in patients with urine protein excretion 40.3 g per 24 hours166 (H. Tighiouart, personal communication). Long-term fol- low-up data from AASK also showed a benefit of a lower target BP in patients with PCR 4220 mg/g (422 mg/ and the ESCAPE trial14 showed a benefit in the entire population with a borderline interaction of treatment target and urine protein level. 