A few studies using ABPM in patients with CKD suggest that it may give a better measure of overall BP and better indicate risk for kidney disease progression than office BP measurement.12,77,323 In fact, the only large RCT of BP control in children with CKD used ABPM as the method for BP assessment.14 Further research may elucidate chapter 6 http://www.kidney-international.org & 2012 KDIGO that future guidelines for therapy should be based on ABPM, rather than office based measures that are commonly used today. We have not recommended ABPM targets in this Guideline as ABPM is currently expensive and not readily available as routine clinical care in many settings. 6.1: We recommend that in children with CKD ND, BP- lowering treatment is started when BP is consistently above the 90th percentile for age, sex, and height. (1C) RATIONALE CVD has long been recognized as a substantial cause of late morbidity and mortality in individuals with onset of CKD The majority of children with CKD are and a substantial proportion show evidence of target-organ damage associated with both masked and confirmed hypertension in a dose dependent fashion.325 However, few RCTs directly comparing thresholds for initiation of BP treatment (vs. no treatment) or targets of BP treatment to prevent or reverse target-organ damage have ever been performed in children with CKD. Observational studies of healthy children suggest that persistent elevations in BP are associated with significant late sequelae. 