This recommendation is weak, according to GRADE, because the potential risks for adverse events from BP lowering may vary depending on the underlying cause of CKD in children. In particular, risks of dehydration, hypotension, and possible AKI may be greater in children with underlying urologic disease that may be associated with xed urine output despite intercurrent gastrointestinal (GI) illness and uid loss or decreased uid intake. There may also be burden due to limitations in available resources associated with BP monitoring via 24-hour ABPM. It places a high value on reduction in kidney disease progression and kidney failure and use of the same BP measurement tech- nique by ABPM as in the single RCT that forms the evidence base. It places a relatively low value on the lack of evidence demonstrating that the clinical bene ts of BP lowering extend to populations characterized by different causes of CKD, level of albuminuria, race and ethnicity, and on the costs and incon- venience associated with BP monitoring using ABPM. Key information Balance of bene ts and harms. This recommendation relies heavily on the data from a single trial (the Effect of Strict Blood Pressure Control and ACE Inhibition on the Progression of CKD in Pediatric Patients [ESCAPE] trial) of 385 participants in which intensi ed BP control (targeting 24-hour MAP <50th percentile of normal children) was compared to standard BP control (targeting 24-hour MAP 50th 99th percentile of normal children; Supplementary Table S401,142,355 ). This study showed a probable bene t in slowing kidney disease progression and no greater risk of adverse events, such as hypotension or acute decrease in GFR. This study in children was not powered for, and did not demonstrate, differences in the critical outcome of all-cause mortality. 