The regimen will not then be altered again unless several BP readings are above (sometimes well above) that target. Because BP fluctuates, there is a good chance that a proportion of the subsequent BP readings will inevitably be above a previously achieved target. One way to circumvent this problem is to set a threshold level for treatment that is lower than the desired target. This strategy has been used in several health care recommendations, including the WHO nutrition goals and the 1997 NKF Dialysis Outcomes Quality Initiative Hemodialysis Adequacy guideline. As previously stated and in line with several previous guidelines on BP management in CKD, we have set the same values for the threshold for treatment and desired target systolic and diastolic levels. We emphasize the value of checking for consistency by using repeated BP measurements to direct therapy and believe that this strategy will improve target attainment. BP is measured infrequently. Traditionally, BP control is audited by measuring the BP in a patient or a group of patients on just one occasion. In an individual patient, the BP can be better assessed by means of repeated clinical measurements over a period of time or by more sophisticated techniques such as home self-measurement of BP or ABPM. Evaluating guideline implementation in a group of patients is difficult, as repeated or more sophisti- cated measurements are not possible in everyone. We have insufficient knowledge of what proportion of patients at any one time will have a BP level above the target value, even when guidelines have been closely followed and adherence has been high. 