In contrast, there was no benefit of ACE-Is as compared to diuretic therapy in the CKD and diabetic subgroups in ALLHAT,279 although, again, few of the study patients were likely to have had frank albuminuria. Moreover, ALLHAT showed clear BP differences in favor of diuretic therapy over ACE-Is, making the comparison between the two groups somewhat difficult. As the RCT data in this population is strong and consistent, the level of evidence is high (see Supplementary Table 37 online). The decision on the grade of this recommendation statement (1B) was made by a majority vote. The minority of Work Group members supported an evidence grade of A. The choice between an ACE-I and an ARB in CKD patients is controversial. In general, the evidence for kidney outcomes that supports the use of ACE-Is is older and applies largely to type 1 diabetes, whereas the evidence supporting the use of ARB comes from more recent trials in type 2 diabetes. For cardiovascular protection in patients with diabetes, the evidence largely points to ACE-Is. The available data are consistent, suggesting the effects of both classes of agents are likely to be similar. Cost and availability may be an important consideration in some countries. However, extra- polations within and between drug classes must be made with care: within-class effects on hard outcomes may differ substantially and may depend on the dose, making extrapolation to other drug classes problematic. A 2004 meta-analysis concluded that there was insufficient evidence on the relative effects of ACE-Is versus ARBs on survival.280 We were unable to find trials directly comparing ACE-Is and ARBs in patients with diabetes and albuminuria. 