In SPRINT, the par- ticipants with CKD who were randomized to intensive antihypertensive therapy (SBP target <120 mm Hg) ap- peared to derive the same beneficial reduction in CVD events and all-cause mortality that was seen in their counterparts without CKD at baseline. Likewise, in- tensive therapy was beneficial even in those 75 years of age with frailty or the slowest gait speed. There was no difference in the principal kidney outcome ( 50% decline in eGFR or ESRD) between the intensive-and standard-therapy (SBP target <140 mm Hg) groups.S9.3-26 Three other RCTsS9.3-1 S9.3-3 have evaluated the effect Figure 6. Management of hypertension in patients with CKD. Colors correspond to Class of Recommendation in Table 1. *CKD stage 3 or higher or stage 1 or 2 with albuminuria 300 mg/d or 300 mg/g creatinine. ACE indicates angiotensin- converting enzyme; ARB, angiotensin receptor blocker; BP blood pressure; and CKD, chronic kidney disease. Whelton et al 2017 High Blood Pressure Clinical Practice Guideline e53 of differing BP goals of <140/90 mm Hg versus 125 130/75 80 mm Hg on CKD progression in patients with CKD. None of these trials demonstrated a benefit for more intensive BP reduction, although post hoc follow- up analyses favored the lower targets in patients with more severe proteinuria,S9.3-38,S9.3-39 and these trials were underpowered to detect differences in CVD event rates. Recent meta-analyses and systematic reviews that in- cluded patients with CKD from SPRINT support more intensive BP treatmentS9.3-40 S9.3-42 to reduce cardiovas- cular events but do not demonstrate a reduction in the rate of progression of kidney disease (doubling of se- rum creatinine or reaching ESRD). More intensive BP treatment may result in a modest reduction in GFR, which is thought to be primarily due to a hemodynamic effect and may be reversible. 