Dr. Jadoul has coauthored over 260 scienti c papers, most of them published in major nephrology journals. He is biographic and disclosure information www.kidney-international.org currently serving as a theme editor of Nephrology Dialysis Transplantation, and he is also a country co-investigator for the Dialysis Outcomes and Practice Patterns Study (DOPPS; 2001 present). In 2008, he received the international distin- guished medal from the US National Kidney Foundation. He was previously a member of the KDIGO Executive Committee (2010 2015) and the ERA-EDTA Council (2013 2016). Presently, Dr. Jadoul is a KDIGO Co-Chair. Consultancy: Astellas*, AstraZeneca*, Merck Sharp & Dohme*, Mundipharma*, and Vifor Fresenius Medical Care Renal Pharma* Expert testimony: Vifor Fresenius Medical Care Renal Pharma* Grants / research support: Amgen*, Janssen-Cilag*, Otsuka*, and Roche* Speaker bureaus: Amgen*, Menarini*, Merck Sharp & Dohme*, Mundipharma, and Vifor Fresenius Medical Care Renal Pharma* Travel: Amgen* and Sano * *Monies paid to institution. Wolfgang C. Winkelmayer, MD, MPH, ScD, is the Gordon A. Cain Chair of Nephrology and professor of medicine at Baylor College of Medicine in Houston, TX, USA. Dr. Winkelmayer received his medical degree (1990) from the Univer- sity of Vienna, Austria, and later earned a Master of Public Health in healthcare management (1999) and a Doctor of Science in health policy (2001) from Harvard University, Cambridge, MA, USA. He then spent 8 years on the faculty of Brigham and Women s Hospital and Harvard Medical School, where he established himself as a proli c investigator and leader in the discipline of comparative-effectiveness research as it pertains to patients with kidney disease. From 2009 to 2014, he was the director of clinical research in the Division of Nephrology at Stanford University School of Medicine, Palo Alto, CA, USA. He assumed his current position as chief of nephrology at Baylor College of Medicine in September 2014. His main areas of research interest include comparative effectiveness and safety research of treatment strategies for anemia, as well as of various interventions for cardiovascular disease in patients with kidney disease. Dr. Winkelmayer is a member of the American Society of Clinical Investigation. His clinical passion lies in providing quality kidney care to the predominantly disadvantaged and un(der)insured population in the public safety net health system of Harris County, Texas. Dr. Winkelmayer has authored over 300 peer-reviewed pub- lications, and he has a particular interest in medical pub- lishing. He currently serves as associate editor for the Journal of the American Medical Association, was a co-editor of the American Journal of Kidney Disease from 2007 to 2016, and has been appointed to several other editorial boards of leading nephrology and epidemiology journals. He also volunteers his time toward important initiatives of the American Society of Nephrology (e.g., Public Policy Board), and he joined KDIGO volunteer leadership as an executive committee member in 2015 and has served as its Co-Chair since 2016. Consultancy: Akebia, Amgen, AstraZeneca, Bayer, Daiichi Sankyo, Relypsa, and Vifor Fresenius Medical Care Renal Pharma Methods Chair Marcello Tonelli, MD, SM, MSc, FRCPC, is senior associate dean (clinical research) at the Cumming School of Medicine in Calgary, Alberta, Canada. He is associate vice president (health research) at the University of Calgary. He received his medical degree from the University of Western Ontario, Canada, a Master of Science in epidemiology from Harvard University, Cambridge, MA, USA, and a Master of Science in health policy from Imperial College London, UK. He is a nephrologist and professor at the University of Calgary. Dr. Tonelli has served in the past as president of the Ca- nadian Society of Nephrology, councilor of the ISN, and a member of the KDIGO Executive Committee. Dr. Tonelli is Chair emeritus of the Canadian Task Force for Preventive Health Care, a national panel of experts that makes recom- mendations about preventive health services to Canada s 36,000 family physicians. A unique aspect of Dr. Tonelli s research program includes partnering with regional, provincial, and national decision makers to ensure that the ndings will be used to produce rational health policy. Speaker bureaus: B. Braun* *Monies donated to charity. Evidence Review Team Jonathan C. Craig, MBChB, DipCH, FRACP, M Med (Clin Epi), PhD, Evidence Review Team Director, is an interna- tionally recognized clinician and scientist and holds the position of vice president and executive dean of the College of Medicine & Public Health at Flinders Univer- sity, Adelaide, South Australia. Professor Craig has made a signi cant contribution to the clinical research landscape in the prevention, identi cation, management, and treatment of CKD, particularly in relation to children and in indigenous communities. He has led the formation of state, national, and interna- tional networks to conduct high-quality, relevant trials in children. He has been instrumental in the development and implementation of best-practice methods and guidelines www.kidney-international.org biographic and disclosure information relating to CKD in Australia and globally. Professor Craig s many current advisory roles include member of the National Health and Medical Research Council s (NHMRC) Health Translation Advisory Committee, the Pharmaceutical Bene ts Advisory Committee, Medical Services Advisory Committee, and Commonwealth Department of Health Life Savings Drug Program. He is a past member of the World Health Organization expert review panel for global strategy and plan of action on public health, innovation and intellectual property; a past chairman of the Steering Group of the Cochrane Collaboration; and a past member of the Expert Advisory Group for the Structural Review of NHMRC s Grant Program. Dr. Craig declared no competing interests. Suetonia C. Palmer, MBChB, FRACP, PhD, Evidence Re- view Team Co-Director, is an academic nephrologist at the University of Otago at Christchurch in New Zealand. She studied medicine at the University of Otago, graduating in 1995. She became a fellow of the Royal Australasian Col- lege of Physicians in Nephrology in 2005. She later completed a PhD in 2010 on the link between kidney function and heart health and a 2-year postdoctoral fellowship in Boston, MA, USA, at the Brigham and Women s Hospital. Dr. Palmer began as an author with the Cochrane Renal Group in 2004 during her training to become a nephrologist. Through systematic reviews, she discovered a passion for understanding more about the amount and quality of evi- dence that are required to make good clinical decisions in nephrology. She is actively engaged in the conduct of sys- tematic reviews of interventions (the treatments we use), prognosis (whether risk factors for disease link to important outcomes), and trial quality (how good is the evidence on which to base our decisions). Dr. Palmer enjoys training others in systematic review and meta-analysis using an evidence-based approach to research. She has strong collaborative links with researchers in Italy, Australia, Europe, and North America with an increasing research output, including recent publications in key internal medicine and nephrology journals. Dr. Palmer declared no competing interests. Giovanni F.M. Strippoli, MD, MPH, M Med (Clin Epi), PhD, Evidence Review Team Co-Director, has made sig- ni cant contributions to clinical research in CKD, with particular focus on prevention of kidney disease, and man- agement of kidney failure, including hemodialysis, peritoneal dialysis, and kidney transplantation. He has contributed strongly to the development of policy in the area of kidney disease management through an international network designing and conducting epidemiologic studies in the eld, including systematic reviews, RCTs, and cohort studies, among others. Professor Strippoli has been an active contributor in his positions as chairman, deputy chairman, and council in nephrology societies including the ISN and the Italian Society of Nephrology, as well as editorial positions in nephrology and general medicine scienti c journals. Dr. Strippoli declared no competing interests. Martin Howell, PhD, Assistant Project Director, is a senior research fellow in health economics in the Sydney School of Public Health (University of Sydney), NSW, Australia. Since 2009, Martin has been responsible for evidence review and synthesis and the development of over 20 clinical practice guidelines for the Kidney Health Australia Caring for Australasians with Renal Impairment (KHA-CARI) guidelines group. His research focuses on applied health economics, predominantly in the areas of assessment of preferences using discrete choice methods and economic evaluations. His PhD project involved the application of a type of choice experiment known as a Best Worst Scaling survey to elicit preferences of recipients of kidney transplants for outcomes after transplantation. This methodology has since been applied to address a diverse range of health-related issues. He is currently leading the economic evaluations of 9 active clinical trials. He is an author on 57 publications ( rst author on 10). These publications show the broad application of his research from clinical trials to translation of clinical evidence to clinical practice guidelines and patient-centered care. Dr. Howell declared no competing interests. David J. Tunnicliffe, PhD, Evidence Review Project Team Leader and Project Manager, is a research fellow at the University of Sydney, School of Public Health, and the Centre for Kid- ney Research at the Children s Hospital at Westmead, NSW, Australia. He was awarded his PhD in 2018 at the Uni- versity of Sydney. David has a research interest in meta-research and the utilization of living evidence in the management of CKD, and teaching epidemiology, which he performs through the Masters (Medicine) Clinical Epidemiology program, as a unit coordinator of introductions to systematic reviews. As part of Cochrane Kidney and Transplant, David has served as the evidence review project team leader and project manager for the 2021 update of the KDIGO 2012 Clinical Practice Guideline for the Management of Blood Pressure in CKD, providing methodological expertise on evidence syn- thesis and guideline development. His role was key in coor- dinating the formation of key clinical questions to guide literature searching and leading data extraction, critical appraisal, meta-analysis, and evidence grading. Dr. Tunnicliffe declared no competing interests. biographic and disclosure information www.kidney-international.org Fiona Russell, PhD, Cochrane Kidney and Transplant, Managing Editor, has more than 20 years experience at media organizations such as News Corp and Fairfax Media in a variety of editorial positions including reporter, sub-editor, deputy editor, and production editor. Two years as an infor- mation technology supervisor led to an ongoing technological change management role at both companies, developing new system procedures and work ows, and providing training solutions for new and existing staff. During her editorial career, Dr. Russell also gained a bachelor s degree in journalism, international relations, and literary studies, a graduate degree in cognitive science, and a PhD in comparative cognition research. She has been the managing editor of Cochrane Kidney and Transplant since October 2015. Grants/grants pending: National Health and Medical Research Council of Australia Gail Y. Higgins, BA, Grad Ed, Grad Dip LibSc, Information Specialist, completed a bachelor s degree in arts, a graduate diploma in education from the University of Sydney, NSW, Australia, and a graduate diploma in Library Science from Kuring-gai College of Advanced Education. Following a number of years as a teacher librarian, she changed tack and spent 3 years with the NSW TAFE Information Systems Di- vision. After that, she joined the University of Sydney Library and worked as a pharmacy librarian and then as an internet training librarian. She has worked as an information specialist for the Cochrane Haematological Malignancies Group in Cologne, Germany, and the Cochrane Cancer Network in Oxford, UK. In 2007 and 2008, she completed a secondment with the World Health Organization in Geneva, Switzerland, on the International Clinical Trials Registry Platform (ICTRP) project. Ms. Higgins declared no competing interests. Tess E. Cooper, MPH, MSc (Evidence-based Health Care), Research Associate, has completed an MSc in evidence-based health care, a Master of Public Health, and a bachelor s degree in population health and marketing. Ms. Cooper is the in- house systematic reviewer for the Cochrane Kidney and Transplant Review Group, based at the University of Sydney, NSW, Australia. In addition, she works with several other Cochrane Review groups, including the Pain; Palliative and Supportive Care; Ear, Nose, and Throat (ENT); and Skin groups, based in the United Kingdom. She has research experience in evidence-based health care, long-term cohort studies, chronic disease prevention, and is a current PhD candidate researching kidney transplant patients. Grants/grants pending: Australian Government PhD scholarship Nicole Evangelidis, MPH, MPhil, Research Associate, is a public health researcher at the Centre for Kidney Research at the University of Sydney, NSW, Australia. She has experience in chronic disease prevention, patient-centered research, and the development of core outcome sets. She is interested in diet and lifestyle changes for the prevention of chronic disease. She undertook key aspects of the evidence review for the KDIGO guideline, including data extraction, synthesis, and preparation of evidence summaries. Ms. Evangelidis declared no competing interests. Brydee Cashmore, MPH, Research Associate, has a Master of Public Health from the University of Sydney, NSW, Australia, as well as a bachelor s degree in science, a double major in physiology and human nutrition, a graduate diploma in science in psychology, and a postgraduate diploma in science in human nutrition from Massey University, New Zealand. She is a researcher at the Centre for Kidney Research at the University of Sydney, where she undertakes evidence review and synthesis for Cochrane Kidney and Transplant and the KHA-CARI Guideline group. She was involved across all of the KDIGO Clinical Practice Guideline on the Manage- ment of Blood Pressure in CKD subtopics and undertook key aspects of the evidence review, including data extraction, evidence synthesis, and the writing and preparation of evi- dence summaries in MAGICapp. Ms. Cashmore declared no competing interests. Rabia Khalid, MND, Research Associate, graduated from the University of Sydney, NSW, Australia, in 2016 with a Master of Nutrition and Dietetics. Since then, she has been working as an accredited practicing dietitian in the community. In 2017, she started her additional role as a researcher at the Centre for Kidney Research, where her role has ranged from helping with guideline development to assisting with and coordinating clinical trials. Her passion lies in increasing the availability of evidence-based knowledge for the general public. Ms. Khalid declared no competing interests. Claris Teng, BPsych (Hons), Research Associate, is a PhD candidate at the University of Sydney, NSW, Australia. Her thesis title is Perspectives and preferences of people with dementia and their caregivers about long-term care: estab- lishing a person-centered framework for decision-making. As a research associate, Ms. Teng undertook key aspects of the evidence review for the KDIGO Clinical Practice Guideline on the Management of Blood Pressure in CKD, including data extraction, synthesis, and preparation of ev- idence summaries. Ms. Teng declared no competing interests. www.kidney-international.org biographic and disclosure information Acknowledgments A special debt of gratitude is owed to the KDIGO Co-Chairs, Michel Jadoul and Wolfgang C. Winkelmayer, and immedi- ate past Co-Chair David C. Wheeler, for their invaluable oversight throughout the development of this guideline. In particular, we thank Jonathan Craig, Martin Howell, David Tunnicliffe, and the ERT members for their substantial contribution to the rigorous assessment of the available evi- dence. We acknowledge Marcello Tonelli and Lyubov Lytvyn for their guidance on strengthening the linkage between the recommendations and the evidence base and for striving to improve on the format to better meet KDIGO s aspiration for a living guideline that is consistently kept up-to-date, and above all, useful and informative to practicing clinicians. We would also like to acknowledge Debbie Maizels for her vital contributions to the artwork presented in this guideline. Lastly, we acknowledge Joseph T. Flynn for his contributions to Chapter 5: Blood pressure management in children with CKD. We are especially grateful to the Work Group members for their expertise throughout the entire process of literature review, data extraction, meeting participation, and the critical writing and editing of the statements and rationale, which made the publication of this guideline possible. The generous gift of their time and dedication is greatly appreciated. Finally, and on behalf of the Work Group, we gratefully acknowledge the careful assessment of the draft guideline by public external reviewers. The Work Group considered all of the valuable comments made, and where appropriate, suggested changes were incorporated into the nal publication. The following individuals and organizations provided feedback during the public review of the draft guideline: Baris Afsar, Ahmed Akl, Laith Al-Rabadi, B lent Altun, Pablo Amair, Mustafa Arici, Lynda Azzouz, George L. Bakris, Rommel Bataclan, Zineb Benjelloun, Patrick Biggar, Juliana Borborema, Victor Botero, Jordi Bover, British and Irish Hypertension Society, Lawrence Byrd, Rolando Claure-Del Granado, Indranil Dasgupta, Ian H. de Boer, Filippo De Stefano, Goffredo Del Rosso, Laura Fiersens, Joseph T. Flynn, Eleni Frangou, Daniel Froment, Alvaro Garcia, Osama Gheith, Richard J. Glassock, Claudia Fernanda Leiva Gomez, Manuel Gorostidi, Remi Goupil, William E. Haley, Tess Harris, Clarissa Havel, Lai Seong Hooi, Fan Hook Hou, Chiu- Ching Huang, R meyza Turan Kazancio glu, Said Khamis, Arif Khwaja, Bernhard Karl Kr mer, Craig B. Langman, Edgar V. Lerma, Lingyun Li, Jose Lima, Jos Ant nio Lopes, Fran- cesca Mallamaci, Partha Pratim Mandal, Roberto Ramirez Marmolejo, Michel Marre, Sandro Mazzaferro, Mehran Raghib Motlagh, Eugen Mota, Martin Myers, Narcisse Oue- draogo, Alberto Ortiz, Fabio Paglialonga, Sa_ Ime Paydas, Carmen A. Peralta, Carlos Eduardo Poli-de-Figueiredo, Harun Rashid, Maria Fernanda Slon Roblero, Nicolas Rob- erto Robles, Cibele Isaac Rodrigues, Patrick Rossignol, Luis M. Ruilope, Rafael Santamaria, Nigar Sekercioglu, Deepak Sharma, Alexander Shutov, Habib Skhiri, Andrew Smyth, Sandra J. Taler, Ekamol Tantisattamo, Nhan Tran, UK Renal Association, Markus van der Giet, Janelle Vicknair, Ji-Guang Wang, Daniel E. Weiner, Paul K. Whelton, Chi Pang Wen, Helen Yeh, Carmine Zoccali, and Muhammed Zubair. Participation in the review does not necessarily consti- tute endorsement of the content of this report by the above individuals or the organizations or institutions they represent. Alfred K. Cheung, MD Johannes F.E. Mann, MD Work Group Co-Chairs acknowledgments www.kidney-international.org References 1. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140:e20171904. 2. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127 e248. 3. Muntner P, Shimbo D, Carey RM, et al. Measurement of blood pressure in humans: a scienti c statement From the American Heart Association. Hypertension. 2019;73:e35 e66. 4. Turner MJ, Speechly C, Bignell N. Sphygmomanometer calibration why, how and how often? Aust Fam Physician. 2007;36:834 838. 5. Agarwal R, Pappas MK, Sinha AD. Masked uncontrolled hypertension in CKD. J Am Soc Nephrol. 2016;27:924 932. 6. Ahmad FS, Chan C, Rosenman MB, et al. Validity of cardiovascular data from electronic sources: the multi-ethnic study of atherosclerosis and HealthLNK. Circulation. 2017;136:1207 1216. 7. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;74:1376 1414. 8. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36:1953 2041. 9. Kallioinen N, Hill A, Horswill MS, et al. Sources of inaccuracy in the measurement of adult patients resting blood pressure in clinical settings: a systematic review. J Hypertens. 2017;35:421 441. 10. Drawz PE, Ix JH. BP Measurement in clinical practice: time to SPRINT to guideline-recommended protocols. J Am Soc Nephrol. 2018;29: 383 388. 11. ONTARGET Investigators, Yusuf S, Teo KK, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358: 1547 1559. 12. de Galan BE, Perkovic V, Ninomiya T, et al. Lowering blood pressure reduces renal events in type 2 diabetes. J Am Soc Nephrol. 2009;20: 883 892. 13. Peralta CA, McClure LA, Scherzer R, et al. Effect of intensive versus usual blood pressure control on kidney function among individuals with prior lacunar stroke: a post hoc analysis of the secondary prevention of Small Subcortical Strokes (SPS3) Randomized Trial. Circulation. 2016;133:584 591. 14. Duncombe SL, Voss C, Harris KC. Oscillometric and auscultatory blood pressure measurement methods in children: a systematic review and meta-analysis. J Hypertens. 2017;35:213 224. 15. Mingji C, Onakpoya IJ, Heneghan CJ, et al. Assessing agreement of blood pressure-measuring devices in Tibetan areas of China: a systematic review. Heart Asia. 2016;8:46 51. 16. Wan Y, Heneghan C, Stevens R, et al. Determining which automatic digital blood pressure device performs adequately: a systematic review. J Hum Hypertens. 2010;24:431 438. 17. Cohen JB, Padwal RS, Gutkin M, et al. History and justi cation of a national blood pressure measurement validated device listing. Hypertension. 2019;73:258 264. 18. Ishikawa J, Nasothimiou EG, Karpettas N, et al. Automatic of ce blood pressure measured without doctors or nurses present. Blood Press Monit. 2012;17:96 102. 19. Stergiou GS, Alpert B, Mieke S, et al. A universal standard for the validation of blood pressure measuring devices: Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ ESH/ISO) collaboration statement. Hypertension. 2018;71:368 374. 20. Roerecke M, Kaczorowski J, Myers MG. Comparing automated of ce blood pressure readings with other methods of blood pressure measurement for identifying patients with possible hypertension: a systematic review and meta-analysis. JAMA Intern Med. 2019;179:351 362. 21. Bauer F, Seibert FS, Rohn B, et al. Attended versus unattended blood pressure measurement in a real life setting. Hypertension. 2018;71:243 249. 22. Campbell NR, Conradson HE, Kang J, et al. Automated assessment of blood pressure using BpTRU compared with assessments by a trained technician and a clinic nurse. Blood Press Monit. 2005;10:257 262. 23. Lamarre-Cliche M, Cheong NN, Larochelle P. Comparative assessment of four blood pressure measurement methods in hypertensives. Can J Cardiol. 2011;27:455 460. 24. Myers MG. Automated blood pressure measurement in routine clinical practice. Blood Press Monit. 2006;11:59 62. 25. Myers MG, McInnis NH, Fodor GJ, et al. Comparison between an automated and manual sphygmomanometer in a population survey. Am J Hypertens. 2008;21:280 283. 26. Johnson KC, Whelton PK, Cushman WC, et al. Blood pressure measurement in SPRINT (Systolic Blood Pressure Intervention Trial). Hypertension. 2018;71:848 857. 27. Stergiou GS, Kollias A, Destounis A, et al. Automated blood pressure measurement in atrial brillation: a systematic review and meta- analysis. J Hypertens. 2012;30:2074 2082. 28. Chan PH, Wong CK, Pun L, et al. Diagnostic performance of an automatic blood pressure measurement device, Microlife WatchBP Home A, for atrial brillation screening in a real-world primary care setting. BMJ Open. 2017;7:e013685. 29. Cohen JB, Lotito MJ, Trivedi UK, et al. Cardiovascular events and mortality in white coat hypertension: a systematic review and meta- analysis. Ann Intern Med. 2019;170:853 862. 30. Pierdomenico SD, Pierdomenico AM, Coccina F, et al. Prognostic value of masked uncontrolled hypertension. Hypertension. 2018;72:862 869. 31. Shimbo D, Muntner P. Should out-of-of ce monitoring be performed for detecting white coat hypertension? Ann Intern Med. 2019;170:890 892. 32. Ghazi L, Yaffe K, Tamura MK, et al. Association of 24-hour ambulatory blood pressure patterns with cognitive function and physical functioning in CKD. Clin J Am Soc Nephrol. 2020;15:455 464. 33. Minutolo R, Gabbai FB, Borrelli S, et al. Changing the timing of antihypertensive therapy to reduce nocturnal blood pressure in CKD: an 8-week uncontrolled trial. Am J Kidney Dis. 2007;50:908 917. 34. Mwasongwe SE, Tanner RM, Poudel B, et al. Ambulatory blood pressure phenotypes in adults taking antihypertensive medication with and without CKD. Clin J Am Soc Nephrol. 2020;15:501 510. 35. Pogue V, Rahman M, Lipkowitz M, et al. Disparate estimates of hypertension control from ambulatory and clinic blood pressure measurements in hypertensive kidney disease. Hypertension. 2009;53: 20 27. 36. Siu AL, U.S. Preventative Services Task Force. Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;163:778 786. 37. Little P, Barnett J, Barnsley L, et al. Comparison of acceptability of and preferences for different methods of measuring blood pressure in primary care. BMJ. 2002;325:258 259. 38. McGowan N, Pad eld PL. Self blood pressure monitoring: a worthy substitute for ambulatory blood pressure? J Hum Hypertens. 2010;24: 801 806. 39. Nasothimiou EG, Karpettas N, Dafni MG, et al. Patients preference for ambulatory versus home blood pressure monitoring. J Hum Hypertens. 2014;28:224 229. 40. Beyhaghi H, Viera AJ. Comparative cost-effectiveness of clinic, home, or ambulatory blood pressure measurement for hypertension diagnosis in US adults. Hypertension. 2019;73:121 131. 41. Lovibond K, Jowett S, Barton P, et al. Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study. Lancet. 2011;378:1219 1230. 42. Eguchi K, Kuruvilla S, Ishikawa J, et al. A novel and simple protocol for the validation of home blood pressure monitors in clinical practice. Blood Press Monit. 2012;17:210 213. www.kidney-international.org references 43. Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee to Review the Dietary Reference Intakes for Sodium and Potassium, Oria M, Harrison M, Stallings VA, eds. Dietary Reference Intakes for Sodium and Potassium. Available at: http://doi.org/10.17226/25353. Accessed January 15, 2021. 44. Clase CM, Carrero JJ, Ellison DH, et al. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2020;97:42 61. 45. He J, Mills KT, Appel LJ, et al. Urinary sodium and potassium excretion and CKD progression. J Am Soc Nephrol. 2016;27:1202 1212. 46. Mills KT, Chen J, Yang W, et al. Sodium excretion and the risk of cardiovascular disease in patients with chronic kidney disease. JAMA. 2016;315:2200 2210. 47. McMahon EJ, Campbell KL, Bauer JD, et al. Altered dietary salt intake for people with chronic kidney disease. Cochrane Database Syst Rev. 2015;2: CD010070. 48. Suckling RJ, He FJ, Macgregor GA. Altered dietary salt intake for preventing and treating diabetic kidney disease. Cochrane Database Syst Rev. 2010:CD006763. 49. Hwang JH, Chin HJ, Kim S, et al. Effects of intensive low-salt diet education on albuminuria among nondiabetic patients with hypertension treated with olmesartan: a single-blinded randomized, controlled trial. Clin J Am Soc Nephrol. 2014;9:2059 2069. 50. Jardine MJ, Li N, Ninomiya T, et al. Dietary sodium reduction reduces albuminuria: a cluster randomized trial. J Ren Nutr. 2019;29:276 284. 51. Keyzer CA, van Breda GF, Vervloet MG, et al. Effects of vitamin D receptor activation and dietary sodium restriction on residual albuminuria in CKD: the ViRTUE-CKD Trial. J Am Soc Nephrol. 2017;28:1296 1305. 52. Konishi Y, Okada N, Okamura M, et al. Sodium sensitivity of blood pressure appearing before hypertension and related to histological damage in immunoglobulin a nephropathy. Hypertension. 2001;38:81 85. 53. Kwakernaak AJ, Krikken JA, Binnenmars SH, et al. Effects of sodium restriction and hydrochlorothiazide on RAAS blockade ef cacy in diabetic nephropathy: a randomised clinical trial. Lancet Diabetes Endocrinol. 2014;2:385 395. 54. McMahon EJ, Bauer JD, Hawley CM, et al. A randomized trial of dietary sodium restriction in CKD. J Am Soc Nephrol. 2013;24:2096 2103. 55. Meuleman Y, Hoekstra T, Dekker FW, et al. Sodium restriction in patients with CKD: a randomized controlled trial of self-management support. Am J Kidney Dis. 2017;69:576 586. 56. Ruilope LM, Casal MC, Guerrero L, et al. Sodium intake does not in uence the effect of verapamil in hypertensive patients with mild renal insuf ciency. Drugs. 1992;44:94 98. 57. Saran R, Padilla RL, Gillespie BW, et al. A randomized crossover trial of dietary sodium restriction in stage 3-4 CKD. Clin J Am Soc Nephrol. 2017;12:399 407. 58. Slagman MC, Waanders F, Hemmelder MH, et al. Moderate dietary sodium restriction added to angiotensin converting enzyme inhibition compared with dual blockade in lowering proteinuria and blood pressure: randomised controlled trial. BMJ. 2011;343:d4366. 59. Lopes de Faria JB, Friedman R, de Cosmo S, et al. Renal functional response to protein loading in type 1 (insulin-dependent) diabetic patients on normal or high salt intake. Nephron. 1997;76:411 417. 60. Luik PT, Hoogenberg K, Van Der Kleij FG, et al. Short-term moderate sodium restriction induces relative hyper ltration in normotensive normoalbuminuric Type I diabetes mellitus. Diabetologia. 2002;45:535 541. 61. Miller JA. Renal responses to sodium restriction in patients with early diabetes mellitus. J Am Soc Nephrol. 1997;8:749 755. 62. Muhlhauser I, Prange K, Sawicki PT, et al. Effects of dietary sodium on blood pressure in IDDM patients with nephropathy. Diabetologia. 1996;39:212 219. 63. Trevisan R, Bruttomesso D, Vedovato M, et al. Enhanced responsiveness of blood pressure to sodium intake and to angiotensin II is associated with insulin resistance in IDDM patients with microalbuminuria. Diabetes. 1998;47:1347 1353. 64. Dodson PM, Beevers M, Hallworth R, et al. Sodium restriction and blood pressure in hypertensive type II diabetics: randomised blind controlled and crossover studies of moderate sodium restriction and sodium supplementation. BMJ. 1989;298:227 230. 65. Houlihan CA, Allen TJ, Baxter AL, et al. A low-sodium diet potentiates the effects of losartan in type 2 diabetes. Diabetes Care. 2002;25:663 671. 66. Imanishi M, Yoshioka K, Okumura M, et al. Sodium sensitivity related to albuminuria appearing before hypertension in type 2 diabetic patients. Diabetes Care. 2001;24:111 116. 67. Petrie JR, Morris AD, Minamisawa K, et al. Dietary sodium restriction impairs insulin sensitivity in noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab. 1998;83:1552 1557. 68. Vedovato M, Lepore G, Coracina A, et al. Effect of sodium intake on blood pressure and albuminuria in Type 2 diabetic patients: the role of insulin resistance. Diabetologia. 2004;47:300 303. 69. Yoshioka K, Imanishi M, Konishi Y, et al. Glomerular charge and size selectivity assessed by changes in salt intake in type 2 diabetic patients. Diabetes Care. 1998;21:482 486. 70. Lambers Heerspink HJ, Holtkamp FA, Parving HH, et al. Moderation of dietary sodium potentiates the renal and cardiovascular protective effects of angiotensin receptor blockers. Kidney Int. 2012;82:330 337. 71. World Health Organization. Guideline: Sodium Intake for Adults and Children. Available at: https://apps.who.int/iris/bitstream/handle/1 January 15, 2021. 72. EFSA Panel on Nutrition. Novel Foods and Food Allergens (NDA), Turck D, Castenmiller J, et al. Dietary reference values for sodium. EFSA J. 2019;17:191. 73. Dunkler D, Dehghan M, Teo KK, et al. Diet and kidney disease in high-risk individuals with type 2 diabetes mellitus. JAMA Intern Med. 2013;173: 1682 1692. 74. Smyth A, Dunkler D, Gao P, et al. The relationship between estimated sodium and potassium excretion and subsequent renal outcomes. Kidney Int. 2014;86:1205 1212. 75. Flesher M, Woo P, Chiu A, et al. Self-management and biomedical outcomes of a cooking, and exercise program for patients with chronic kidney disease. J Ren Nutr. 2011;21:188 195. 76. Greenwood SA, Koufaki P, Mercer TH, et al. Effect of exercise training on estimated GFR, vascular health, and cardiorespiratory tness in patients with CKD: a pilot randomized controlled trial. Am J Kidney Dis. 2015;65: 425 434. 77. Headley S, Germain M, Wood R, et al. Short-term aerobic exercise and vascular function in CKD stage 3: a randomized controlled trial. Am J Kidney Dis. 2014;64:222 229. 78. Howden EJ, Coombes JS, Strand H, et al. Exercise training in CKD: ef cacy, adherence, and safety. Am J Kidney Dis. 2015;65:583 591. 79. Ikizler TA, Robinson-Cohen C, Ellis C, et al. Metabolic effects of diet and exercise in patients with moderate to severe CKD: a randomized clinical trial. J Am Soc Nephrol. 2018;29:250 259. 80. Leehey DJ, Collins E, Kramer HJ, et al. Structured exercise in obese diabetic patients with chronic kidney disease: a randomized controlled trial. Am J Nephrol. 2016;44:54 62. 81. Leehey DJ, Moinuddin I, Bast JP, et al. Aerobic exercise in obese diabetic patients with chronic kidney disease: a randomized and controlled pilot study. Cardiovasc Diabetol. 2009;8:62. 82. Van Craenenbroeck AH, Van Craenenbroeck EM, Van Ackeren K, et al. Effect of moderate aerobic exercise training on endothelial function and arterial stiffness in CKD stages 3-4: a randomized controlled trial. Am J Kidney Dis. 2015;66:285 296. 83. Heiwe S, Jacobson SH. Exercise training in adults with CKD: a systematic review and meta-analysis. Am J Kidney Dis. 2014;64:383 393. 84. Beddhu S, Wei G, Marcus RL, et al. Light-intensity physical activities and mortality in the United States general population and CKD subpopulation. Clin J Am Soc Nephrol. 2015;10:1145 1153. 85. Ekinci EI, Clarke S, Thomas MC, et al. Dietary salt intake and mortality in patients with type 2 diabetes. Diabetes Care. 2011;34:703 709. 86. Mente A, O Donnell M, Rangarajan S, et al. Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: a community- level prospective epidemiological cohort study. Lancet. 2018;392:496 506. 87. BiCARB study group. Clinical and cost-effectiveness of oral sodium bicarbonate therapy for older patients with chronic kidney disease and low-grade acidosis (BiCARB): a pragmatic randomised, double- blind, placebo-controlled trial. BMC Med. 2020;18:91. 88. Mahajan A, Simoni J, Sheather SJ, et al. Daily oral sodium bicarbonate preserves glomerular ltration rate by slowing its decline in early hypertensive nephropathy. Kidney Int. 2010;78:303 309. references www.kidney-international.org 89. Raphael KL, Isakova T, Ix JH, et al. A randomized trial comparing the safety, adherence, and pharmacodynamics pro les of two doses of sodium bicarbonate in CKD: the BASE Pilot Trial. J Am Soc Nephrol. 2020;31:161 174. 90. Graudal NA, Hubeck-Graudal T, Jurgens G. Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database Syst Rev. 2017;4:CD004022. 91. Cheung AK, Rahman M, Reboussin DM, et al. Effects of intensive BP control in CKD. J Am Soc Nephrol. 2017;28:2812 2823. 92. ACCORD Study Group, Cushman WC, Evans GW, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362:1575 1585. 93. SPRINT Research Group, Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103 2116. 94. Lewington S, Clarke R, Qizilbash N, et al. Age-speci c relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360: 1903 1913. 95. Schrier RW. Blood pressure in early autosomal dominant polycystic kidney disease. N Engl J Med. 2015;372:976 977. 96. Pajewski NM, Berlowitz DR, Bress AP, et al. Intensive vs standard blood pressure control in adults 80 years or older: a secondary analysis of the Systolic Blood Pressure Intervention Trial. J Am Geriatr Soc. 2020;68:496 504. 97. Klahr S, Levey AS, Beck GJ, et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modi cation of Diet in Renal Disease Study Group. N Engl J Med. 1994;330:877 884. 98. Wright JT Jr, Bakris G, Greene T, et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA. 2002;288:2421 2431. 99. Ruggenenti P, Perna A, Loriga G, et al. Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease (REIN- 2): multicentre, randomised controlled trial. Lancet. 2005;365:939 946. 100. Curb JD, Pressel SL, Cutler JA, et al. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Systolic Hypertension in the Elderly Program Cooperative Research Group. JAMA. 1996;276:1886 1892. 101. SPS3 Study Group, Benavente OR, Coffey CS, et al. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet. 2013;382:507 515. 102. Bundy JD, Li C, Stuchlik P, et al. Systolic blood pressure reduction and risk of cardiovascular disease and mortality: a systematic review and network meta-analysis. JAMA Cardiol. 2017;2:775 781. 103. Blood Pressure Lowering Treatment Trialists Collaboration. Blood pressure-lowering treatment based on cardiovascular risk: a meta- analysis of individual patient data. Lancet. 2014;384:591 598. 104. Czernichow S, Zanchetti A, Turnbull F, et al. The effects of blood pressure reduction and of different blood pressure-lowering regimens on major cardiovascular events according to baseline blood pressure: meta- analysis of randomized trials. J Hypertens. 2011;29:4 16. 105. Ettehad D, Emdin CA, Kiran A, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387:957 967. 106. Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet. 2016;387:435 443. 107. Williamson JD, Supiano MA, Applegate WB, et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged $75 years: a randomized clinical trial. JAMA. 2016;315:2673 2682. 108. SPRINT MIND Investigators for the SPRINT Research Group, Williamson JD, Pajewski NM, et al. Effect of intensive vs standard blood pressure control on probable dementia: a randomized clinical trial. JAMA. 2019;321:553 561. 109. Brunstrom M, Carlberg B. Association of blood pressure lowering with mortality and cardiovascular disease across blood pressure levels: a systematic review and meta-analysis. JAMA Intern Med. 2018;178:28 36. 110. Blood Pressure Lowering Treatment Trialists Collaboration, Ninomiya T, Perkovic V, et al. Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta- analysis of randomised controlled trials. BMJ. 2013;347:f5680. 111. Malhotra R, Nguyen HA, Benavente O, et al. Association between more intensive vs less intensive blood pressure lowering and risk of mortality in chronic kidney disease stages 3 to 5: a systematic review and meta-analysis. JAMA Intern Med. 2017;177:1498 1505. 112. Garrison SR, Kolber MR, Korownyk CS, et al. Blood pressure targets for hypertension in older adults. Cochrane Database Syst Rev. 2017;8: CD011575. 113. Bavishi C, Bangalore S, Messerli FH. Outcomes of intensive blood pressure lowering in older hypertensive patients. J Am Coll Cardiol. 2017;69:486 493. 114. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ. 1998;317:703 713. 115. Staessen JA, Fagard R, Thijs L, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet. 1997;350:757 764. 116. Schrier RW, Estacio RO, Esler A, et al. Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes. Kidney Int. 2002;61:1086 1097. 117. Ruilope LM, Salvetti A, Jamerson K, et al. Renal function and intensive lowering of blood pressure in hypertensive participant of the hypertension optimal treatment (HOT) study. J Am Soc Nephrol. 2001;12:218 225. 118. Brunstrom M, Carlberg B. Effect of antihypertensive treatment at different blood pressure levels in patients with diabetes mellitus: systematic review and meta-analyses. BMJ. 2016;352:i717. 119. Papademetriou V, Zaheer M, Doumas M, et al. Cardiovascular outcomes in action to control cardiovascular risk in diabetes: impact of blood pressure level and presence of kidney disease. Am J Nephrol. 2016;43: 271 280. 120. Bress AP, King JB, Kreider KE, et al. Effect of intensive versus standard blood pressure treatment according to baseline prediabetes status: a post hoc analysis of a randomized trial. Diabetes Care. 2017;40:1401 1408. 121. Perkovic V, Rodgers A. Rede ning Blood-Pressure Targets SPRINT Starts the Marathon. N Engl J Med. 2015;373:2175 2178. 122. Beddhu S, Chertow GM, Greene T, et al. Effects of intensive systolic blood pressure lowering on cardiovascular events and mortality in patients with type 2 diabetes mellitus on standard glycemic control and in those without diabetes mellitus: reconciling results from ACCORD BP and SPRINT. J Am Heart Assoc. 2018;7:e009326. 123. Tsujimoto T, Kajio H. Bene ts of Intensive blood pressure treatment in patients with type 2 diabetes mellitus receiving standard but not intensive glycemic control. Hypertension. 2018;72:323 330. 124. Buckley LF, Dixon DL, Wohlford GFt, et al. Intensive versus standard blood pressure control in SPRINT-Eligible participants of ACCORD-BP. Diabetes Care. 2017;40:1733 1738. 125. Aggarwal R, Petrie B, Bala W, et al. Mortality outcomes with intensive blood pressure targets in chronic kidney disease patients. Hypertension. 2019;73:1275 1282. 126. Bangalore S, Messerli FH, Wun CC, et al. J-curve revisited: an analysis of blood pressure and cardiovascular events in the Treating to New Targets (TNT) Trial. Eur Heart J. 2010;31:2897 2908. 127. D Agostino RB, Belanger AJ, Kannel WB, et al. Relation of low diastolic blood pressure to coronary heart disease death in presence of myocardial infarction: the Framingham Study. BMJ. 1991;303:385 389. 128. Beddhu S, Greene T, Boucher R, et al. Intensive systolic blood pressure control and incident chronic kidney disease in people with and without diabetes mellitus: secondary analyses of two randomised controlled trials. Lancet Diabetes Endocrinol. 2018;6:555 563. 129. Beddhu S, Chertow GM, Cheung AK, et al. In uence of baseline diastolic blood pressure on effects of intensive compared with standard blood pressure control. Circulation. 2018;137:134 143. 130. Kirchheim HR, Ehmke H, Hackenthal E, et al. Autoregulation of renal blood ow, glomerular ltration rate and renin release in conscious dogs. P ugers Arch. 1987;410:441 449. 131. Malhotra R, Craven T, Ambrosius WT, et al. Effects of intensive blood pressure lowering on kidney tubule injury in CKD: a longitudinal subgroup analysis in SPRINT. Am J Kidney Dis. 2019;73:21 30. 132. Zhang WR, Craven TE, Malhotra R, et al. Kidney damage biomarkers and incident chronic kidney disease during blood pressure reduction: a case- control study. Ann Intern Med. 2018;169:610 618. www.kidney-international.org references 133. Nadkarni GN, Chauhan K, Rao V, et al. Effect of intensive blood pressure lowering on kidney tubule injury: ndings from the ACCORD Trial study participants. Am J Kidney Dis. 2019;73:31 38. 134. Beddhu S, Rocco MV, Toto R, et al. Effects of intensive systolic blood pressure control on kidney and cardiovascular outcomes in persons without kidney disease: a secondary analysis of a randomized trial. Ann Intern Med. 2017;167:375 383. 135. Appel LJ, Wright JT Jr, Greene T, et al. Intensive blood-pressure control in hypertensive chronic kidney disease. N Engl J Med. 2010;363:918 929. 136. Beck GJ, Berg RL, Coggins CH, et al. Design and statistical issues of the Modi cation of Diet in Renal Disease Trial. The Modi cation of Diet in Renal Disease Study Group. Control Clin Trials. 1991;12:566 586. 137. Upadhyay A, Earley A, Haynes SM, et al. Systematic review: blood pressure target in chronic kidney disease and proteinuria as an effect modi er. Ann Intern Med. 2011;154:541 548. 138. Sarnak MJ, Greene T, Wang X, et al. The effect of a lower target blood pressure on the progression of kidney disease: long-term follow-up of the modi cation of diet in renal disease study. Ann Intern Med. 2005;142:342 351. 139. Modi cation of Diet in Renal Disease Study Group. Short-term effects of protein intake, blood pressure, and antihypertensive therapy on glomerular ltration rate in the Modi cation of Diet in Renal Disease Study. J Am Soc Nephrol. 1996;7:2097 2109. 140. Lv J, Ehteshami P, Sarnak MJ, et al. Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis. CMAJ. 2013;185:949 957. 141. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney Int Suppl. 2012;2: 337 414. 142. ESCAPE Trial Group, Wuhl E, Trivelli A, et al. Strict blood-pressure control and progression of renal failure in children. N Engl J Med. 2009;361:1639 1650. 143. Pahor M, Shorr RI, Somes GW, et al. Diuretic-based treatment and cardiovascular events in patients with mild renal dysfunction enrolled in the systolic hypertension in the elderly program. Arch Intern Med. 1998;158:1340 1345. 144. Ku E, Gassman J, Appel LJ, et al. BP Control and long-term risk of ESRD and mortality. J Am Soc Nephrol. 2017;28:671 677. 145. Ku E, Glidden DV, Johansen KL, et al. Association between strict blood pressure control during chronic kidney disease and lower mortality after onset of end-stage renal disease. Kidney Int. 2015;87:1055 1060. 146. Chan JC, So WY, Yeung CY, et al. Effects of structured versus usual care on renal endpoint in type 2 diabetes: the SURE study: a randomized multicenter translational study. Diabetes Care. 2009;32:977 982. 147. Estacio RO, Coll JR, Tran ZV, et al. Effect of intensive blood pressure control with valsartan on urinary albumin excretion in normotensive patients with type 2 diabetes. Am J Hypertens. 2006;19:1241 1248. 148. Lewis JB, Berl T, Bain RP, et al. Effect of intensive blood pressure control on the course of type 1 diabetic nephropathy. Collaborative Study Group. Am J Kidney Dis. 1999;34:809 817. 149. Juraschek SP, Taylor AA, Wright JT Jr, et al. Orthostatic Hypotension, cardiovascular outcomes, and adverse events: results from SPRINT. Hypertension. 2020;75:660 667. 150. Rocco MV, Sink KM, Lovato LC, et al. Effects of intensive blood pressure treatment on acute kidney injury events in the Systolic Blood Pressure Intervention Trial (SPRINT). Am J Kidney Dis. 2018;71:352 361. 151. Obi Y, Kalantar-Zadeh K, Shintani A, et al. Estimated glomerular ltration rate and the risk-bene t pro le of intensive blood pressure control amongst nondiabetic patients: a post hoc analysis of a randomized clinical trial. J Intern Med. 2018;283:314 327. 152. Nguyen LS. Effect of additional antihypertensive medications in patients with high-risk hypertension: a post hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial) database. J Clin Hypertens (Greenwich). 2018;20:814 815. 153. Markovitz AA, Mack JA, Nallamothu BK, et al. Incremental effects of antihypertensive drugs: instrumental variable analysis. BMJ. 2017;359: j5542. 154. Bress AP, Bellows BK, King JB, et al. Cost-effectiveness of intensive versus standard blood-pressure control. N Engl J Med. 2017;377:745 755. 155. Wang MC, Tsai WC, Chen JY, et al. Stepwise increase in arterial stiffness corresponding with the stages of chronic kidney disease. Am J Kidney Dis. 2005;45:494 501. 156. Zhang L, Zhao F, Yang Y, et al. Association between carotid artery intima-media thickness and early-stage CKD in a Chinese population. Am J Kidney Dis. 2007;49:786 792. 157. National Institute for Health and Care Excellence. Hypertension in adults: diagnosis and management. NICE guideline [NG136]. Available at: 2021. 158. Nerenberg KA, Zarnke KB, Leung AA, et al. Hypertension Canada s 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Can J Cardiol. 2018;34:506 525. 159. Hiremath S, Sapir-Pichhadze R, Nakhla M, et al. Hypertension Canada s 2020 evidence review and guidelines for the management of resistant hypertension. Can J Cardiol. 2020;36:625 634. 160. Muntner P, Carey RM, Jamerson K, et al. Rationale for ambulatory and home blood pressure monitoring thresholds in the 2017 American College of Cardiology/American Heart Association Guideline. Hypertension. 2019;73:33 38. 161. Rahman M, Pressel S, Davis BR, et al. Renal outcomes in high-risk hypertensive patients treated with an angiotensin-converting enzyme inhibitor or a calcium channel blocker vs a diuretic: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch Intern Med. 2005;165:936 946. 162. Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345:851 860. 163. HOPE Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Heart Outcomes Prevention Evaluation Study Investigators. Lancet. 2000;355:253 259. 164. The EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators. Ef cacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo- controlled, multicentre trial (the EUROPA study). Lancet. 2003;362: 782 788. 165. Solomon SD, Rice MM, Jablonski KA, et al. Renal function and effectiveness of angiotensin-converting enzyme inhibitor therapy in patients with chronic stable coronary disease in the Prevention of Events with ACE inhibition (PEACE) trial. Circulation. 2006;114:26 31. 166. Jafar TH, Schmid CH, Landa M, et al. Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. A meta- analysis of patient-level data. Ann Intern Med. 2001;135:73 87. 167. Mann JF, Gerstein HC, Pogue J, et al. Renal insuf ciency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med. 2001;134:629 636. 168. Dagenais GR, Pogue J, Fox K, et al. Angiotensin-converting-enzyme inhibitors in stable vascular disease without left ventricular systolic dysfunction or heart failure: a combined analysis of three trials. Lancet. 2006;368:581 588. 169. Xie X, Liu Y, Perkovic V, et al. Renin-angiotensin system inhibitors and kidney and cardiovascular outcomes in patients with CKD: a Bayesian network meta-analysis of randomized clinical trials. Am J Kidney Dis. 2016;67:728 741. 170. Gashti CN, Bakris GL. The role of calcium antagonists in chronic kidney disease. Curr Opin Nephrol Hypertens. 2004;13:115 161. 171. Williams B, MacDonald TM, Morant S, et al. Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. Lancet. 2015;386:2059 2068. 172. Hripcsak G, Suchard MA, Shea S, et al. Comparison of cardiovascular and safety outcomes of chlorthalidone vs hydrochlorothiazide to treat hypertension. JAMA Intern Med. 2020;180:542 551. 173. Lederle FA, Cushman WC, Ferguson RE, et al. Chlorthalidone versus hydrochlorothiazide: a new kind of veterans affairs cooperative study. Ann Intern Med. 2016;165:663 664. 174. Moran AE, Whelton PK, Frieden TR. Chlorthalidone and hydrochlorothiazide for treatment of patients with hypertension. JAMA Intern Med. 2020;180:1132 1133. 175. Jentzer JC, DeWald TA, Hernandez AF. Combination of loop diuretics with thiazide-type diuretics in heart failure. J Am Coll Cardiol. 2010;56: 1527 1534. 176. The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia). Randomised placebo-controlled trial of effect of ramipril on decline in references www.kidney-international.org glomerular ltration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet. 1997;349:1857 1863. 177. Ruggenenti P, Perna A, Gherardi G, et al. Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. Lancet. 1999;354:359 364. 178. Maschio G, Alberti D, Janin G, et al. Effect of the angiotensin-converting- enzyme inhibitor benazepril on the progression of chronic renal insuf ciency. The Angiotensin-Converting-Enzyme Inhibition in Progressive Renal Insuf ciency Study Group. N Engl J Med. 1996;334: 939 945. 179. Hou FF, Zhang X, Zhang GH, et al. Ef cacy and safety of benazepril for advanced chronic renal insuf ciency. N Engl J Med. 2006;354:131 140. 180. Jafar TH, Stark PC, Schmid CH, et al. Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta- analysis. Ann Intern Med. 2003;139:244 252. 181. Hou FF, Xie D, Zhang X, et al. Renoprotection of Optimal Antiproteinuric Doses (ROAD) Study: a randomized controlled study of benazepril and losartan in chronic renal insuf ciency. J Am Soc Nephrol. 2007;18:1889 1898. 182. Hannedouche T, Landais P, Goldfarb B, et al. Randomised controlled trial of enalapril and beta blockers in non-diabetic chronic renal failure. BMJ. 1994;309:833 837. 183. Rakugi H, Ogihara T, Umemoto S, et al. Combination therapy for hypertension in patients with CKD: a subanalysis of the Combination Therapy of Hypertension to Prevent Cardiovascular Events trial. Hypertens Res. 2013;36:947 958. 184. Esnault VL, Brown EA, Apetrei E, et al. The effects of amlodipine and enalapril on renal function in adults with hypertension and nondiabetic nephropathies: a 3-year, randomized, multicenter, double- blind, placebo-controlled study. Clin Ther. 2008;30:482 498. 185. Marin IR, Ruilope LM. Effect of antihypertensive treatment on progression of renal insuf ciency in non-diabetics patients (ESPIRAL Trial). Nefrologia. 1995;15:464 475. 186. Zucchelli P, Zuccala A, Borghi M, et al. Long-term comparison between captopril and nifedipine in the progression of renal insuf ciency. Kidney Int. 1992;42:452 458. 187. Woo KT, Choong HL, Wong KS, et al. Aliskiren and losartan trial in non- diabetic chronic kidney disease. J Renin Angiotensin Aldosterone Syst. 2014;15:515 522. 188. Mimura T, Takenaka T, Kanno Y, et al. Vascular compliance is secured under angiotensin inhibition in non-diabetic chronic kidney diseases. J Hum Hypertens. 2008;22:38 47. 188a. Ihle BU, Whitworth JA, Shahinfar S, et al. Angiotensin-converting enzyme inhibition in nondiabetic progressive renal insuf ciency: a controlled double-blind trial. Am J Kidney Dis. 1996;27:489 495. 189. Cinotti GA, Zucchelli PC, Collaborative Study Group. Effect of Lisinopril on the progression of renal insuf ciency in mild proteinuric non- diabetic nephropathies. Nephrol Dial Transplant. 2001;16:961 966. 190. Shen PC, He LQ, Yang XJ, Cao H X. Renal protection of losartan 50 mg in normotensive Chinese patients with nondiabetic chronic kidney disease. J Investig Med. 2012;60:1041 1047. 191. Nakamura T, Kanno Y, Takenaka T, Suzuki H. An angiotensin receptor blocker reduces the risk of congestive heart failure in elderly hypertensive patients with renal insuf ciency. Hypertens Res. 2005;28: 415 423. 192. Ando K, Ohtsu H, Uchida S, et al. Anti-albuminuric effect of the aldosterone blocker eplerenone in non-diabetic hypertensive patients with albuminuria: a double-blind, randomised, placebo-controlled trial. Lancet Diabetes Endocrinol. 2014;2:944 953. 193. Chung EYM, Ruospo M, Natale P, et al. Aldosterone antagonists in addition to renin angiotensin system antagonists for preventing the progression of chronic kidney disease. Cochrane Database of Syst Rev. 2020;10:CD007004. 194. Edwards NC, Steeds RP, Stewart PM, et al. Effect of spironolactone on left ventricular mass and aortic stiffness in early-stage chronic kidney disease: a randomized controlled trial. J Am Coll Cardiol. 2009;54:505 512. 195. Zannad F, McMurray JJ, Krum H, et al. Eplerenone in patients with systolic heart failure and mild symptoms. N Engl J Med. 2011;364:11 21. 196. Herzog CA, Asinger RW, Berger AK, et al. Cardiovascular disease in chronic kidney disease. A clinical update from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2011;80:572 586. 197. Heart Outcomes Prevention Evaluation Study Investigators, Yusuf S, Sleight P, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342:145 153. 198. Mann JF, Schmieder RE, DyalL,etal. Effectoftelmisartanonrenal outcomes: a randomized trial. Ann Intern Med. 2009;151:1 10. W11 W12. 199. Wright JT Jr, Dunn JK, Cutler JA, et al. Outcomes in hypertensive black and nonblack patients treated with chlorthalidone, amlodipine, and lisinopril. JAMA. 2005;293:1595 1608. 200. Brenner BM, Cooper ME, de Zeeuw D, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345:861 869. 201. Gerstein HC, Mann JF, Pogue J, et al. Prevalence and determinants of microalbuminuria in high-risk diabetic and nondiabetic patients in the Heart Outcomes Prevention Evaluation Study. The HOPE Study Investigators. Diabetes Care. 2000;23(suppl 2):B35 B39. 202. Mann JF, Gerstein HC, Yi QL, et al. Progression of renal insuf ciency in type 2 diabetes with and without microalbuminuria: results of the Heart Outcomes and Prevention Evaluation (HOPE) randomized study. Am J Kidney Dis. 2003;42:936 942. 203. Maschio G, Alberti D, Locatelli F, et al. Angiotensin-converting enzyme inhibitors and kidney protection: the AIPRI trial. The ACE Inhibition in Progressive Renal Insuf ciency (AIPRI) Study Group. J Cardiovasc Pharmacol. 1999;(suppl 1):S16 S20. discussion S41 S43. 204. Bakris GL, Barnhill BW, Sadler R. Treatment of arterial hypertension in diabetic humans: importance of therapeutic selection. Kidney Int. 1992;41:912 919. 205. Bakris GL, Slataper R, Vicknair N, et al. ACE inhibitor mediated reductions in renal size and microalbuminuria in normotensive, diabetic subjects. J Diabetes Complications. 1994;8:2 6. 206. Bojestig M, Karlberg BE, Lindstrom T, et al. Reduction of ACE activity is insuf cient to decrease microalbuminuria in normotensive patients with type 1 diabetes. Diabetes Care. 2001;24:919 924. 207. Capek M, Schnack C, Ludvik B, et al. Effects of captopril treatment versus placebo on renal function in type 2 diabetic patients with microalbuminuria: a long-term study. Clin Investig. 1994;72:961 966. 208. Chase HP, Garg SK, Harris S, et al. Angiotensin-converting enzyme inhibitor treatment for young normotensive diabetic subjects: a two- year trial. Ann Ophthalmol. 1993;25:284 289. 209. Cordonnier DJ, Pinel N, Barro C, et al. Expansion of cortical interstitium is limited by converting enzyme inhibition in type 2 diabetic patients with glomerulosclerosis. The Diabiopsies Group. J Am Soc Nephrol. 1999;10: 1253 1263. 210. Crepaldi G, Carta Q, Deferrari G, et al. Effects of lisinopril and nifedipine on the progression to overt albuminuria in IDDM patients with incipient nephropathy and normal blood pressure. The Italian Microalbuminuria Study Group in IDDM. Diabetes Care. 1998;21:104 110. 211. Garg SK, Chase HP, Jackson WE, et al. Renal and retinal changes after treatment with ramipril and pentoxifyline in subjects with IDDM. Ann Ophthalmol Glaucoma. 1998;30:33 37. 212. Hommel E, Jensen B, Parving H. Long-term effect of captopril on kidney function in normotensive insulin dependent diabetic patients (iddm) with diabetic nephropathy [abstract]. J Am Soc Nephrol. 1995;6:450. 213. Katayama S, Kikkawa R, Isogai S, et al. Effect of captopril or imidapril on the progression of diabetic nephropathy in Japanese with type 1 diabetes mellitus: a randomized controlled study (JAPAN-IDDM). Diabetes Res Clin Pract. 2002;55:113 121. 214. Laffel LM, McGill JB, Gans DJ. The bene cial effect of angiotensin- converting enzyme inhibition with captopril on diabetic nephropathy in normotensive IDDM patients with microalbuminuria. North American Microalbuminuria Study Group. Am J Med. 1995;99:497 504. 215. Marre M, Lievre M, Chatellier G, et al. Effects of low dose ramipril on cardiovascular and renal outcomes in patients with type 2 diabetes and raised excretion of urinary albumin: randomised, double blind, placebo controlled trial (the DIABHYCAR study). BMJ. 2004;328:495. 216. Mathiesen ER, Hommel E, Giese J, et al. Ef cacy of captopril in postponing nephropathy in normotensive insulin dependent diabetic patients with microalbuminuria. BMJ. 1991;303:81 87. 217. Mauer M, Zinman B, Gardiner R, et al. Renal and retinal effects of enalapril and losartan in type 1 diabetes. N Engl J Med. 2009;361:40 51. 218. Nankervis A, Nicholls K, Kilmartin G, et al. Effects of perindopril on renal histomorphometry in diabetic subjects with microalbuminuria: a 3-year placebo-controlled biopsy study. Metabolism. 1998;47:12 15. 219. Parving HH, Hommel E, Damkjaer Nielsen M, et al. Effect of captopril on blood pressure and kidney function in normotensive insulin dependent diabetics with nephropathy. BMJ. 1989;299:533 536. www.kidney-international.org references 220. Phillips PJ, Phillipou G, Bowen KM, et al. Diabetic microalbuminuria and cilazapril. Am J Med. 1993;94:58s 60s. 221. Ravid M, Savin H, Jutrin I, et al. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med. 1993;118:577 581. 222. Romero R, Salinas I, Lucas A, et al. Renal function changes in microalbuminuric normotensive type II diabetic patients treated with angiotensin-converting enzyme inhibitors. Diabetes Care. 1993;16:597 600. 223. Sano T, Kawamura T, Matsumae H, et al. Effects of long-term enalapril treatment on persistent micro-albuminuria in well-controlled hypertensive and normotensive NIDDM patients. Diabetes Care. 1994;17:420 424. 224. Lewis EJ, Hunsicker LG, Bain RP, et al. The effect of angiotensin- converting-enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med. 1993;329:1456 1462. 225. The EUCLID Study Group. Randomised placebo-controlled trial of lisinopril in normotensive patients with insulin-dependent diabetes and normoalbuminuria or microalbuminuria. Lancet. 1997;349:1787 1792. 226. Ahmad J, Sha que S, Abidi SM, et al. Effect of 5-year enalapril therapy on progression of microalbuminuria and glomerular structural changes in type 1 diabetic subjects. Diabetes Res Clin Pract. 2003;60:131 138. 227. Ahmad J, Siddiqui MA, Ahmad H. Effective postponement of diabetic nephropathy with enalapril in normotensive type 2 diabetic patients with microalbuminuria. Diabetes Care. 1997;20:1576 1581. 228. Hansen KW, Klein F, Christensen PD, et al. Effects of captopril on ambulatory blood pressure, renal and cardiac function in microalbuminuric type 1 diabetic patients. Diabete Metab. 1994;20:485 493. 229. Jerums G, Allen TJ, Campbell DJ, et al. Long-term renoprotection by perindopril or nifedipine in non-hypertensive patients with Type 2 diabetes and microalbuminuria. Diabet Med. 2004;21:1192 1199. 230. Jerums G, Allen TJ, Campbell DJ, et al. Long-term comparison between perindopril and nifedipine in normotensive patients with type 1 diabetes and microalbuminuria. Am J Kidney Dis. 2001;37:890 899. 231. Muirhead N, Feagan BF, Mahon J, et al. The effects of valsartan and captopril on reducing microalbuminuria in patients with type 2 diabetes mellitus: a placebo-controlled trial. Curr Therapeutic Res. 1999;60:650 660. 232. O Hare P, Bilbous R, Mitchell T, et al. Low-dose ramipril reduces microalbuminuria in type 1 diabetic patients without hypertension: results of a randomized controlled trial. Diabetes Care. 2000;23:1823 1829. 233. Winocour PH, Waldek S, Anderson DC. Converting enzyme inhibition and kidney function in normotensive diabetic patients with persistent microalbuminuria. Br Med J (Clin Res Ed). 1987;295:391. 234. Imai E, Chan JC, Ito S, et al. Effects of olmesartan on renal and cardiovascular outcomes in type 2 diabetes with overt nephropathy: a multicentre, randomised, placebo-controlled study. Diabetologia. 2011;54:2978 2986. 235. Mehdi UF, Adams-Huet B, Raskin P, et al. Addition of angiotensin receptor blockade or mineralocorticoid antagonism to maximal angiotensin-converting enzyme inhibition in diabetic nephropathy. J Am Soc Nephrol. 2009;20:2641 2650. 236. Barnett AH, Bain SC, Bouter P, et al. Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med. 2004;351:1952 1961. 237. 