For a 68-year-old man with CKD and diabetes and an ACR of 75 mg/mmol, which is the most appropriate target blood pressure?

• A. < 120/80
• B. < 130/80
• C. < 140/90
• D. < 150/90

Answer: (B)

In chronic kidney disease with diabetes, especially when albuminuria is present, tighter blood pressure control helps protect kidney function and reduce cardiovascular risk. An ACR of 75 mg/mmol indicates albumin leakage and higher risk, so aiming for a systolic <130 and diastolic <80 mmHg provides a balance of renal protection and tolerability in an older patient. Going much lower (like <120/80) can increase the risk of dizziness or falls in the elderly, while targets such as <140/90 or <150/90 miss the added kidney and CV protection that tighter control offers in albuminuric CKD. Therefore, the best target is a blood pressure below 130/80 mmHg.