There may be a higher risk of adverse events with aggressive BP control in individuals who are prone to become dehydrated and are at risk of AKI. This is especially relevant to children with CKD and congenital anomalies of the kidney and urinary tract (CAKUT) who may be unable to concentrate urine and have a salt-losing nephropathy.357 On the other hand, there are potential CV end-organ bene ts, such as less left ventricular hypertrophy.358 The single RCT of BP control and kidney failure outcomes in the pediatric CKD population utilized 24-hour MAP as the Additionally, the AHA Scienti c Statement on pediatric ABPM currently considers ABPM as the gold stan- dard metric for the assessment of BP in children, as stronger associations have been reported between ABPM and target organ damage in children compared with clinic BP values.359 Targeting BP control by ABPM in children with CKD is also recommended by the American Academy of Pediatrics However, in clinics that do not have the capacity to provide ABPM, performance of standardized, protocol-driven manual BP measurement using an aneroid sphygmoma- nometer is a reasonable alternative. Such standardized manual BP measurement provides prognostic information similar to that provided by ABPM.360,361 Data from the Chronic Kidney Disease in Children Study (CKiD) further demonstrate that manual auscultatory clinic BPs taken in a protocol-driven setting are not inferior to ambulatory BP in the discrimination of BP-related adverse outcomes in children However, it must be emphasized that, despite their prognostic utility, RCTs targeting standardized manual BP with meaningful clinical outcomes are not available in children. Proper technique is essential for BP measurement. BP should be measured in the right arm using standard practices, similar to the method used for adults (see Figure 2 in Chapter 1). 