There is insuf cient in- formation to differentiate between men and women for this recommendation. However, data from ALLHAT demon- strated that ACEi as initial therapy for high BP in patients of African origin was inferior to chlorthalidone for stroke and combined CV outcomes.199 ALLHAT did not measure urine protein or albumin. Rationale We make this recommendation, albeit weak, because the CV bene ts appear to outweigh the potential adverse risks; there- fore, many well-informed patients with CKD not on dialysis with moderately increased albuminuria but without diabetes will opt for treatment with RASi. We feel that patients would put a large value on the CV bene ts of RASi and are willing to tolerate its potential harms, including hyperkalemia and AKI. These side effects, however, may lead to higher healthcare costs from additional visits and laboratory testing. Recommendation 3.2.3: We recommend starting RASi (ACEi or ARB) for people with high BP, CKD, and moderately-to-severely increased albuminuria (G1 G4, A2 and A3) with diabetes (1B). This is a strong recommendation based on evidence from RCTs of suf cient duration to evaluate kidney protection in patients with diabetes and CKD. This recommendation places a relatively higher value on preventing long-term progression of CKD and a relatively lower value on the risks of AKI or hyperkalemia, which are often transient. Where data are available, analyses by albuminuria subgroup are provided. Key information Balance of bene ts and harms. The 2 main studies demon- strating kidney bene t from RASi independent of BP control in diabetes were the three-arm IDNT162 and the two-arm www.kidney-international.org chapter 3 studies where ARB was compared with placebo200 or with placebo and with CCB in a double-blinded manner.162 IDNT excluded participants with normal BP; RENAAL included those with and without high BP. 