Very importantly, however, the evidence challenges any tendency toward therapeutic nihilism in the very elderly with high BP and CKD 1 3. Two Japanese studies failed to show any benefit or harm from reducing systolic BP to o140 mm Hg in otherwise healthy elderly patients.393,394 The Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive Patients (JATOS) aimed to assess optimal systolic BP in elderly hypertensive patients and randomized 4418 patients with essential hypertension aged 65 to 85 years with a systolic BP 4160 mm Hg to strict BP control (target systolic BP o140 mm Hg) or mild BP control (target systolic Patients with SCr of Z1.5 mg/dl (133 mmol/l) were excluded, as were patients with multiple co-morbidities. Achieved mean SD systolic BP was 135.9 11.7 mm Hg in the strict-control group and 145.6 11.1 in the mild-control group (Po0.001), with significantly more drugs required in the strict-control group. There was no difference in cerebrovascular, cardiac, or kidney end points, nor in total mortality between the two groups at 2 years of follow-up. Renal failure occurred in 8 and 9 patients, respectively. Rates of treatment withdrawal due to adverse events did not differ between the groups. 