It is even more difficult to make recommendations in patients over 80 years of age with CKD due to the lack of evidence. With consideration given to the adverse effects of treatment, the Work Group felt that it was good practice to ask elderly patients treated for high BP about postural dizziness and to measure BP immediately (within 1 minute) and a few minutes after standing as well as in the sitting position.44 METHODS FOR BP REDUCTION IN THE ELDERLY Lifestyle modifications in the elderly, although often recommended, can compromise quality of life and may impair nutrition. The place of salt restriction, exercise and weight control is detailed in the aforementioned ACCF/AHA Given that there is very little evidence to support lifestyle modifications in the treatment of BP in CKD patients in general, the Work Group decided not to make any such recommendations in the elderly with CKD. Although salt restriction might seem to be the most attractive intervention, it may impact the quality of life, particularly enjoyment of food. A recent observational study of elderly persons (Z65 years of age) does not support alcohol restriction as an intervention to reduce decline in GFR.398 The Work Group felt that drug regimens should be tailored by carefully considering the elderly patient s co-morbidities and any changes in treatment should be very gradual. Close attention should be paid to potential adverse events related to BP treatment, including electrolyte disorders, acute deteriora- tion in kidney function and orthostatic hypotension. Although many elderly patients with CKD will require several agents, studies comparing use of various agents in the elderly without CKD have produced somewhat conflicting results (see Supple- mentary Tables 66 68 online). The ability of the patient to adhere to complex poly-pharmacy should be taken into consi- deration. 