Observational studies and registry data311 315 demon- strate that more than half of children with CKD have high BP based upon a casual BP reading. Observational data also suggest that hypertensive children with CKD progress to kidney failure significantly faster than normotensive children In studies of young adults with kidney failure whose kidney disease began in childhood, the risk of cardiovascular death is extremely high.316,317 Sudden cardiac death is the main cause of cardiac death in these In light of the high prevalence and substantial morbidity associated with elevated BP in children with CKD, we systematically reviewed the existing literature and previously published guideline statements regarding the management of elevated BP in this vulnerable population. As RCTs are considered to provide the strongest evidence for CPGs, we reviewed RCTs with kidney and cardiovascular outcomes in which children with CKD was the study population. We supplemented this limited RCT evidence with information obtained from case series, cohort studies, and previous guideline statements on BP in healthy children and children with CKD. We further described the evidence base in detail in the narrative following each recommendation statement. The strict evidence-based approach of formulating recommendations may have resulted in statements that do not include some commonly accepted treatment practices in children. The rationale for this approach is that we do not wish to provide guideline recommendations and discourage research in areas where evidence is weak. The research recommendations listed at the end of the chapter illustrate areas where more evidence is needed. BACKGROUND Definitions. For this Guideline, the age range for children is defined as from birth through 18 years. 