Rationale The Work Group considered the balance between bene ts and harms, evidence quality, values and preferences, as well as resource utilization in making this recommendation. Primary evidence comes from the ESCAPE trial in which children with baseline CKD with eGFR 20 80 ml/min per 1.73 m2 hour average ambulatory MAP >95th percentile were ran- domized to <50th percentile versus 50th 90th percentile of MAP in the nomogram of healthy children. Both arms received ramipril. The primary composite endpoint of 50% chapter 5 www.kidney-international.org GFR decline and ESKD favored the intensive BP arm (HR: Existing guidelines from other organizations include the 2016 ESH guidelines for management of high BP in chil- dren and adolescents, which promote the use of ausculta- tory of ce measurements and BP targets in children with CKD of <75th percentile of normal children (and <50th percentile if proteinuric). This recommendation is based on a post hoc analysis from the ESCAPE study.142 Obser- vational data on standardized auscultatory of ce moni- toring in the CKiD cohort suggest achieved of ce SBP and DBP <90th percentile offers protection against kidney function decline, compared to of ce SBP and DBP >90th percentile in children with CKD, with potential additional bene t of even lower of ce BP levels in children with non- glomerular forms of CKD.369 Additionally, observational data illustrate that higher levels of proteinuria are most strongly associated with poor BP control and worsening BP Targeting BP control by ABPM in children with CKD is also recommended by the AAP. The AAP 2017 Pediatric Hyper- tension guideline recommends that children or adolescents with both CKD and hypertension should be treated to lower 24-hour MAP to <50th percentile of the distribution of BP of healthy children, as measured using ABPM. 