A recent individual patient-level meta-analysis of 18 trials comprising 15,294 patients with CKD (de ned as an ) found that intensive BP lowering resulted in a signi cantly lower risk of mortality compared to less-intensive BP lowering; this bene t was consistent across multiple subgroups.111 This meta-analysis included RCTs that compared a range of target BPs, but it also included trials comparing antihypertensive agents with placebo or no treatment. Evidence of the effects of an SBP target of <120 mm Hg versus <140 mm Hg in patients with CKD without diabetes is available only from SPRINT.91 There were 53 deaths per 1000 participants in the standard BP control arm, and 40 deaths per 1000 participants in the intensive BP control arm, resulting in a statistically signi cant difference of 13 fewer per 1000 participants; Supplementary Table S1191,93 ) This dif- ference is also evident when the CKD subgroups in both ACCORD (comprised all patients with diabetes) and SPRINT (comprised no patients with diabetes) are combined. www.kidney-international.org chapter 3 Adverse effects. Some practitioners may be concerned about adverse events associated with the low SBP target. Although the Work Group cautions about these possibilities, regardless of the level of SBP, age, and comorbidities, the available evidence shows that the SBP target of <120 mm Hg is generally safe. In a patient with severe carotid stenosis, an SBP <120 mm Hg may be insuf cient to maintain cerebral perfusion, and even an SBP of 150 mm Hg may be insuf cient. Diligence in monitoring the patient and taking the appropriate actions of adjusting BP, administration of anticoagulants, or surgical correction of the stenosis may be necessary. 