Although intuitively there must be a lower limit for safe BP control in the elderly and very elderly, there will probably never be an RCT designed specifically to address this limit in these populations. We can, however, gain insights from observations among elderly patients on treatment as outlined While these date do not allow us to recommend a lower BP limit on treatment, they do suggest that in the elderly, it may be prudent not to reduce BP much below the target BP o140/90 mm Hg as recommended by ACCF/AHA In addressing the risks associated with low BP in the elderly, it is relevant that orthostatic hypotension is more common than in younger populations, particularly among those treated for high BP or diabetes and those receiving As well as causing postural dizziness, low BP is associated with a higher risk of falls and fractures in elderly persons in studies that are likely to have included individuals with and without CKD.9,10,358,397 An additional consideration when treating elderly CKD patients is that they may differ from those with well preserved kidney function in terms of their response to BP lowering agents. The Work Group decided that it was not possible to recommend specific BP targets in the elderly with CKD. A reasonable approach might be to use BP targets as recom- mended in the younger CKD population (r140/90 mm Hg in non-albuminuric CKD and r130/80 mm Hg in albumi- nuric CKD as in Chapters 3 and 4), but to reach these targets gradually, bearing in mind that they may not be achievable without adverse effects particularly in a patient with multiple age-related co-morbidities. It is even more difficult to make recommendations in patients over 80 years of age with CKD due to the lack of evidence. 