Long-term fol- low-up data from AASK also showed a benefit of a lower target BP in patients with PCR 4220 mg/g (422 mg/ and the ESCAPE trial14 showed a benefit in the entire population with a borderline interaction of treatment target and urine protein level. In summary, we believe there is sufficient evidence to suggest a BP target of r130/80 mm Hg for kidney protection in those with macroalbuminuria. We have graded this suggestion 2C, for the following reasons. The reported benefits in the AASK and the MDRD study are based on post hoc and subgroup analyses. Furthermore, in both the MDRD study and AASK, MAP was targeted rather than systolic and diastolic BP, and a specific MAP may translate into different systolic and diastolic BP, depending on the individual patient. Additionally, in the MDRD study, a higher MAP was targeted in patients over the age of 60 years.169 The Ramipril Efficacy in Nephropathy 2 (REIN-2) study did not show a benefit of tight BP control, although admittedly this was a short-term study with relatively few outcomes and it is unclear whether the use of a dihydropyridine calcium-channel blocker (felodipine) in the low-target arm may have confounded (See Supplementary Tables 2 4 online). We also do not believe that this recommendation should in any way hinder trials from randomizing patients with CKD and urine protein excretion o1 g per 24 hours to various BP targets, as there is sufficient equipoise and uncertainty to endorse these trials. One such trial that will evaluate this question is Systolic Blood Pressure Intervention Trial (SPRINT) which is funded by National Institutes of Health (NIH).171,172 It will evaluate cardiovascular and kidney outcomes in patients randomized to a systolic BP of o140 mm Hg versus o120 mm Hg. 