Long-term follow-up in the AASK study demonstrated a benefit of lower target BPs in patients with It is unclear whether this PCR cutoff can be translated into an albumin-level cutoff, as this conversion is likely to be dependent on the type of kidney disease, and the ratio of glomerular albuminuria to tubular proteinuria. In the Effect of Strict Blood Pressure Control and ACE-Inhibition on Progression of Chronic Renal Failure in Pediatric Patients (ESCAPE) study,14 a lower BP target was of benefit in reducing the risk of kidney outcomes, particularly in children with higher urine protein levels (P 0.06 for interaction of treatment target with urine protein level). There have been no BP target trials involving CKD patients focused on hard CVD outcomes. Subgroup analyses from the Hypertension Optimal Treatment (HOT) did not show a benefit for CVD outcomes in association with a lower diastolic BP target in CKD patients, although the statistical power to detect a difference was limited (n 470 for those with a creatinine level 41.5 mg/dl [133 mmol/l]). Furthermore, albuminuria data were not available. Because patients with CKD and microalbuminuria are at high risk, and given that the evidence does not support using different BP targets in non-diabetics and diabetics (see Chapter 4), the Work Group suggests a BP target of r130/80 mm Hg. This ensures consistency among recommendations between persons with diabetes and those without diabetes and facilitates implementation into clinical practice. 3.3: We suggest that non-diabetic adults with CKD ND and urine albumin excretion 4300 mg per 24 hours (or equivalent*) whose office BP is consistently 4130 mm Hg systolic or 480 mm Hg diastolic be treated with BP-lowering drugs to maintain a BP that is consistently r130 mm Hg systolic and r80 mm Hg diastolic. 