Among children with CKD, observational data have shown that those with hypertension (i.e., BP above the 95th percentile) have a more rapid decline in estimated GFR than those without hypertension.313,331 In a study by the European Study Group of Nutritional Treatment of Chronic Renal Failure in Childhood, children with a systolic BP 4120 mm Hg had a significantly faster decline in GFR.332 In children who have received a kidney transplant, hyperten- sion is a strong predictor of accelerated GFR decline333 and Preliminary data from the ongoing observa- tional Chronic Kidney Disease in Children (CKiD) study show that, among 425 children with repeated measures of GFR, having systolic BP above the 90th percentile for age, sex, and height is associated with faster progression of CKD as compared with lower BP.336 In this cohort, the annualized percent change in GFR among those with systolic BP above with systolic BP between the 50th percentiles and 2.5 (95% CI 8.9 3.9) in those with systolic BP below the percentile. In the ESCAPE trial (described in detail in the next section), the kidney survival rate was 66% during follow-up among those with systolic BP below the 90th percentile but only 41% among those with systolic BP above percentile (P 0.0002). In ESCAPE, a diastolic BP below the 90th percentile was associated with a kidney survival rate of 67%, compared to 28% among those with diastolic BP above the 90th (F. Schaefer and E. Wuhl, personal communication). On the basis of the RCT evidence, observational data, and other guidelines, the Work Group graded this recommendation as 1C. The quality of evidence was graded as C because the RCT evidence is limited to inferred evidence from one trial. 