In most countries, generic CCBs and generic ARBs are inexpensive. In resource-limited settings, these drugs are most likely to be available at even lower cost. Given the high nancial and human cost of graft failure, and the relatively low cost of CCB or ARB, it is likely that the initiation of a CCB or ARB would be cost-effective.353 However, a formal economic analysis evaluating different antihypertensive agents in the kidney transplantation setting has not been Considerations for implementation. High BP can be dif cult to control in kidney transplant recipients, and most patients will require more than 1 antihypertensive agent.299 301 This recommendation is for the selection of an initial antihy- pertensive agent with the understanding that other medi- cations may be required to achieve BP control. Patients with evidence of volume overload and high BP should be treated with diuretics before considering an ARB or CCB. Women trying to conceive or who are pregnant should be treated with a CCB, which is generally safe during preg- nancy and lactation, whereas ARB is contraindicated in these conditions. In kidney transplant recipients with pro- teinuria and high BP, ARB should be considered rst given the known proteinuria-lowering effects of these In the early posttransplant period, ARBs should be avoided until kidney transplant function stabilizes, as the acute negative effect of an ARB on GFR can be confused with other causes of graft dysfunction (e.g., rejection). For most other subgroups of transplant patients (e.g., elderly, diabetic), an ARB or CCB should be considered as the rst-line antihypertensive agent. Most, if not all patient subgroups, would value graft survival as a high-priority outcome. The choice of class (i.e., ARB vs. CCB) and speci c agent should be based on local availability and cost. 