Nonetheless, it should be noted that patients with white-coat hyperten- sion were not excluded in SPRINT and other major outcome trials. www.kidney-international.org chapter 3  Severe hypertension, such as SBP $180 mm Hg on no or 1 antihypertensive drug, or $150 mm Hg on >4 antihyper- tensive drugs, because such patients were not included in SPRINT. Uncertainty in risk bene t ratios in the various scenarios above does not necessarily imply that intensive SBP lowering is not warranted. It only re ects the lack of RCT data to support or refute the ratios. If the patient cannot tolerate SBP <120 mm Hg despite a slow, gradual decrease in SBP over months, efforts should be made to maintain SBP <130 mm Hg, <140 mm Hg, or an even higher tolerated SBP goal. Individualization based on trial and error prevails, as in many aspects of medical practice. The importance of standardized BP measurement when applying this guideline cannot be overemphasized. Routine, non-standardized of ce BP mea- surements often, but not invariably, overestimate BP compared to measurements under standardized conditions (Chapter 1). Importantly, the extent to which routine mea- surements overestimate or underestimate standardized of ce BP is highly variable between and within patients; therefore, no correction factor can be used to convert routine BP to standardized BP measurement by calculation. The use of routine measurements to adjust BP-lowering therapy confers a serious risk of overtreatment and sometimes undertreat- ment. It should be emphasized that the most important aspect of standardized BP measurement is preparation prior to the measurement and not the equipment used (Chapter 1). Heterogeneity in primary outcomes among various RCTs. 