groups carry an increased risk of cardiovascular events, as evidenced by multiple cohort studies.55–57 Table 1 | Preparations for blood pressure measurement Office or home7–9 No talking or use of smartphone during the procedure No exercise, nicotine, or caffeine for at least 30 minutes prior to measurement Remove clothing covering location of cuff Seated comfortably with legs uncrossed and back and arm supported for at least 5 minutes prior to measurement Verify cuff size is correct Middle of the cuff should be placed at the level of the right atrium Automatic oscillometric measurements10,11 Average of 2–5 measurements at intervals of 1–2 minutes Normal office BP High home or ambulatory BP High office BP High home or ambulatory BP Masked hypertension Sustained hypertension Normal office BP Normal home or ambulatory BP High office BP Normal home or ambulatory BP Sustained normotension White coat hypertension Home or ambulatory BP Office BP Figure 1 | Classification of patients based on the comparison of office blood pressure (BP) with home or ambulatory BP levels in untreated individuals. Large randomized trials with hard clinical outcomes have primarily targeted office BP values; therefore, clinical benefits of targeting home or ambulatory BP values are still unclear. Modified from Parati G, Ochoa JE, Bilo G, et al. Hypertension in chronic kidney disease part 1: out-of-office blood pressure monitoring: methods, thresholds, and patterns. Hypertension. 2016;67:1093–1101. Available at: https://www. Accessed February 22, 2019.17 Copyright ª 2016 American Heart Association, Inc. KDIGO executive conclusions AK Cheung et al.: Blood pressure in kidney disease: A KDIGO conference report 1028 Kidney International (2019) 95, 1027–1036 BP can vary in the short term (minute-to-minute), medium term (day-to-day), or longer term (visit-to-visit variability, VVV). More advanced CKD is associated with higher VVV of SBP,58 and higher VVV in CKD is associated with adverse cardiovascular outcomes, adverse renal outcomes, and death. In a study of 114,900 patients with CKD,58 higher VVV of SBP, independent of absolute levels of SBP, was associated with higher rates of heart failure, hemorrhagic stroke, and death. Despite the prognostic information provided by VVV of SBP, conference participants felt that its use in the clinical setting or as a target of therapy remains unclear. Conclusions and ongoing controversies in BP measurement Conference participants suggested that the future guideline work group should explicitly state which BP measurements should be used to diagnose and manage BP in CKD. Standardized office BP measurement is rarely performed in clinical practice.7 Given that casual BP tends to provide higher values than other techniques, but more standardized techniques are often used in RCTs targeting BP, conference participants urged the future guideline work group to consider whether office BP should be measured using an automated oscillometric device with the appropriate preparations, as outlined as Table 1. Conference participants also encouraged exploration of the evidence on out-of-office BP measurements in conjunction with office BP measurements in an updated guideline. More data are also needed regarding whether abnormal diurnal BP patterns can be restored in patients with CKD, and whether this strategy would improve clinical outcomes. MANAGING BLOOD PRESSURE IN CKD PATIENTS WITH AND WITHOUT DIABETES Salt intake Lifestyle, including diet, is an integral component of BP management. Conference participants indicated that Recommendation 2.3.2 on salt intake (Chapter 2 of the 2012 KDIGO BP Guideline1 ) should be reviewed to identify new evidence specific to people with CKD, as debate about optimal salt intake in the general population is ongoing.59 The conference participants questioned whether a level 1C recommendation is too strong based on the current evidence.60,61 Therapeutic thresholds and targets of BP In light of new research findings, especially from SPRINT, each recommendation in the 2012 BP guideline regarding BP diagnosis thresholds and treatment targets1 should be considered for revision. Whether separate recommendations are needed for diabetes mellitus and non-diabetes mellitus, and for different levels of albuminuria, depends in large part on where the threshold is set for lower-risk patients. For example, if the threshold is SBP 1 g/d was an explicit exclusion criterion in SPRINT. Indeed, a post hoc analysis of SPRINT suggested that the balance of risk and benefit from intensive BP lowering depended on the severity of CKD, with no apparent net benefit among patients with eGFR 300 mg/g [>30 mg/ mmol]) while some favor the preferential use of an ACEi or ARB for all CKD patients with diabetes and hypertension. The evidence favoring their preferential use for nondiabetic patients with CKD and moderately increased albuminuria (i.e., 6.0 mmol/l) within 1 day of a measurement of serum potassium was very large, amounting to 31.6 for those without CKD, 19.5 for those with CKD G3, 11.6 for those with CKD G4, and 8.0 for those with