A meta-analysis of observational studies conducted prior to 2002, including nearly 1 million subjects selected for having no previously known vascular disease, indicated that the rates of stroke, ischemic heart disease, and overall mortality increased with increasing BP, even among subjects 60 to 89 years of age, although the RR decreased with increasing age.21 RCTs involving elderly patients not selected for having CKD indicate that it is beneficial to treat high BP in patients 460 years of age. A 2009 Cochrane review of 15 RCTs in which persons 460 years of age with a systolic BP Z140 mm Hg or a diastolic BP Z90 mm Hg at baseline received either placebo or a BP-lowering agent indicated that active treatment reduced total mortality (RR 0.90; 95% CI 0.84 0.97) and total cardiovascular mortality and morbidity (RR 0.72; 95% CI 0.68 0.77), particularly due to a reduction in the incidence of stroke.389 Withdrawals due to adverse events were poorly documented, but in three RCTs that did report these data, treatment was associated with 111 events/ 1000 patient-years, as compared with 65 events/1000 patient- years with placebo (RR 1.71; 95% CI 1.45 2.00). Although these findings support treatment of high BP in subjects 460 years of age, they do not inform us specifically about patients with CKD nor about the target BP and they suggest that some patients will have adverse reactions to drug therapy. Of concern is that in this Cochrane review,389 when patients aged Z80 years were specifically considered, there was no overall reduction in the risk of total mortality with treatment of BP vs. no treatment (RR 1.01; 95% CI 0.90 1.13), although the reduction in risk of cardiovascular mortality (RR 0.75; 95% CI 0.65 0.87) was similar to that seen in patients 60 to 80 years of age. 