The Work Group discussed whether it would be preferable to recommend a target range (lowest to highest) for BP rather than just a single target for highest acceptable BP. Although the benefits of lowering BP in CKD have been demonstrated, allowing us to recommend that we should aim for BP consis- tently r140/90 mm Hg when albumin excretion is o30 mg per 24 hours and r130/80 mm Hg if albumin excretion is Z30 mg per 24 hours in both non-diabetic (Chapter 3) and diabetic (Chapter 4) adults with CKD ND, we were unable to give any recommendations for a lower BP target level due to a lack of evidence. There are observational data that support the intuitive notion that excessive BP reduction might be harmful, at least in trials that have not specifically recruited CKD patients. In a cohort of 4071 very elderly (Z80 years) ambulatory American veterans (hence 96.6% males) with hypertension on 1.7 1.2 (mean SD) antihypertensive medication classes, a J-shaped survival curve was noted when the relationship between both systolic and diastolic pressure and survival was examined. The optimum survival was associated with the ranges of diastolic BP between 70 79mm Hg and systolic BP between 130- In another smaller study (n 331) of mortality with 2 year follow-up in elderly hospitalized subjects 470 years with vascular disease or hypertension, the longest survival was observed when diastolic BP was in the range 71 80mm Hg, with a pronounced increase in risk with diastolic BP r60mmHg.410 Further evidence to discourage aggressive reduction in BP in high risk groups comes from secondary analyses of outcomes associated with achieved BPs in the context of large RCTs. 