J Am Soc Nephrol 2009; 20: 1199 209 with permission from American Society of Nephrology400 conveyed through Copyright Clearance Center, Inc.; accessed http://jasn.asnjournals.org/ content/20/6/1199.long. Chapter 8: Future directions and controversies INTRODUCTION In this chapter, we discuss issues regarding BP management and the use of BP-lowering drugs in CKD patients that are currently the subject of ongoing research or controversy and for which there is insufficient evidence upon which to base a recommendation at this time. 8.1: ASSESSMENT OF BP The RCTs on which this Guideline is based involved standard office BP measurements, with the exception of the ESCAPE trial in children.14 In clinical practice BP assessment typically involves measurements made in the clinic or office. In RCTs, the protocols for BP measurement usually require one or more BP readings taken after a period of rest and avoiding prior activities that may have effects on BP. As far as it is possible these protocols should be followed in clinical practice if this evidence is used to guide management. The techniques for office BP measurement and associated problems are well described in the hypertension litera- There is no reason to believe that office BP measurement should be performed differently in CKD patients than in non-CKD patients, other than a strong emphasis be placed on measuring supine or sitting and standing BP because of the increased likelihood of orthostatic hypotension associated with volume depletion, autonomic neuropathy, older age, and drug effects.44,45,374,375 Measuring BP in the general community and in particular, patients with essential hypertension, is becoming increasingly sophisticated. Examples include technologies that assess usual BP as distinct from the BP measured at an office visit and new ways of measuring BP, beyond just systolic and diastolic pressures. Gradually, these advances are being implemented in research and BP management in CKD patients. 