The presence of diabetic retinopathy in a CKD patient may also influence BP target and choice of agent as outlined in Chapter 4. Based on these considerations, the Work Group concluded that it is good clinical practice to assess the risks and benefits of BP-lowering treatment in an individual patient and to tailor therapy accordingly. 2.2: Inquire about postural dizziness and check for postural hypotension regularly when treating CKD patients with BP-lowering drugs. (Not Graded) RATIONALE Patients with CKD, particularly the elderly31 and diabetic patients with autonomic neuropathy, are prone to orthostatic which may be exacerbated by volume depletion. Many CKD patients will require combinations of drugs to control BP including vasodilators, which can cause or exacerbate postural hypotension. This can lead to postural dizziness, reduced adherence and in extreme cases, syncope http://www.kidney-international.org chapter 2 & 2012 KDIGO or falls with consequent injury. Accordingly, it is sensible to regularly check for symptoms of postural dizziness and to compare lying, sitting and standing BP in CKD patients, particularly before and after altering the treatment regimen. LIFESTYLE MODIFICATION The impact of lifestyle-related factors on BP and the risk of cardiovascular and other diseases have been well documented. A number of observational studies in the general population have linked factors such as salt intake,46 weight and body mass and alcohol intake49 with BP level. RCTs addressing many of these factors have been undertaken, the results of which have led the authors of BP guidelines for the general population9 (e.g., JNC 7) to make specific recommendations about the management of lifestyle as a key component of BP management. Individuals with CKD generally have higher9 BP levels than people with normal kidney function and their BP may be particularly sensitive to some factors related to lifestyle. 