(2D) RATIONALE In adult kidney transplant recipients we consider two primary outcomes from the standpoint of BP: graft function and CVD. High BP is well recognized as an important risk factor for both decline in graft function and develop- ment of CVD.153,284 288 Increased levels of both systolic and diastolic BP are associated with worse graft survival over a 7-year period after transplantation,289 and maintaining a systolic BP o140 mm Hg at 3 years after transplantation is associated with improved graft survival and reduced cardiovascular mortality at 10 years.290 Similarly, high BP is associated with an increased risk of graft loss and all-cause Although no RCT defines BP targets in adult kidney transplant recipients for clinically important end points such as graft survival, cardiovascular events, or all-cause mortality, our suggestion is that the BP target should not deviate from the recommended target of r130/80 mm Hg as defined in the recent KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients,292 since there have been no recent data to contradict this recommendation. Although the European Best Practice Guidelines for Renal Transplantation 2002 recommended a target BP r125/ 75 mm Hg in proteinuric patients, there is no evidence to differentiate BP target based on albumin excretion in renal Because adult CKD T patients are at high risk for both graft loss and development of CVD,284 288 we favor a target of r130/80 mm Hg rather than a target of r140/90 mm Hg. We recognize that this recommendation is based on observational data and have therefore given it a grade of 2D. 5.2: In adult kidney transplant recipients, choose a BP- lowering agent after taking into account the time after transplantation, use of calcineurin inhibitors, presence or absence of persistent albuminuria, and other co-morbid conditions. 