The relationships between CKD and BP in the elderly in the
United States have recently been reviewed in detail.369 Among
NHANES III (1988–1994) subjects aged Z60 years of age,
either treated or not treated for a high BP, there was a
J-shaped relationship between BP and CKD prevalence. Thus,
persons with a systolic BP of 120 to 159mmHg or a diastolic
BP of 80 to 99mmHg had the lowest CKD prevalence, with a
higher prevalence associated with a systolic BP o120mmHg
or diastolic BP o80mmHg and a systolic BP Z160mmHg
or a diastolic BP Z100mmHg.361 Analyses of data from
the Kidney Early Evaluation Program (KEEP), as well as
NHANES, indicate that with increasing age, there is an
increase in the prevalence and severity of CKD, confirming the
strong relationship between BP and CKD in the elderly.370,371
Despite these findings, there is little evidence on which to
base recommendations for BP management in elderly
patients with CKD. Systematic assessment of the evidence
base underpinning this Guideline shows that many RCTs
excluded patients 470 years of age. The mean age of
participants rarely exceed 65 years with the upper limit of the
95% CI (i.e., the mean±2 SD) very uncommonly being Z85
years, meaning no more than about 2.5% of the study
population had an age above this cut-off point (Supplementary
Table 65 online). We therefore cannot draw much direct
evidence from these RCTs to indicate how to properly
manage BP in elderly CKD patients, although some
inferences might be drawn from BP studies in elderly
populations not specifically chosen for the presence of CKD