The recommendations of the ACC/AHA 2005 prac- tice guidelines on PAD55 include the following: (1) Antihypertensive therapy should be administered to hyperten- sive patients with lower-extremity PAD to achieve a goal of <140/90 mmHg (nondiabetics) or <130/80 mmHg (diabetics and individuals with chronic renal disease) to reduce the risk of MI, stroke, congestive HF, and cardiovascular death (Level of Evidence A); (2) -adrenergic blocking drugs are effective antihypertensive agents and are not contraindicated in patients with PAD (Level of EvidenceA); (3) the use ofACE inhibitors orARBs is reasonable for patients with symptomatic (Level of Evidence B) or asymptomatic (Level of Evidence C) leg PAD. 1.1.9. Chronic Kidney Disease There has been a steady increase in the prevalence of CKD, defined as kidney damage, documented by kidney biopsy or serum markers for 3 months, or a decrease in glomerular filtration rate to <60 mL min 1 Kidney failure, defined as a glomerular filtration rate of <15 , and end-stage renal disease, which neces- sitates the initiation of treatment by replacement therapy,22 afflicts >525000 patients in the United States, 65% of whom are on long-term hemodialysis.56 Hypertension represents a major independent risk factor for renal failure, with a preva- lence of 28% in hypertensive patients.56 In patients with CKD, cardiovascular death is more likely than progression to end- stage renal disease, and in patients with end-stage renal dis- ease, CVD is the leading cause of death, being 5 to 30 times higher in patients on dialysis than in the general population.57 Even in patients with lower stages of CKD, the risk of CVD is increased independently of other risk factors, and even the smallest degree of albuminuria increases risk for CVD and all- In this patient population, hypertension itself is a leading cause of renal failure. 