The Study on Evaluation of Candesartan Cilexetil after Renal Transplantation (SECRET) was an RCT of candesartan The primary outcome was all-cause mortality, cardiovascular morbidity, or graft failure. Enroll- ment of 700 patients was planned, but unfortunately, the study was terminated prematurely due to lower-than- expected event rates after enrollment of 502 participants because only 26 events took place in the 20 months of follow- up (with no difference in frequency between the two arms), whereas 210 events had been predicted over 3 years. Although there was slightly better BP control in the active group versus the control group (mean BP, 131/80 mm Hg vs. 137/ 83 mm Hg, respectively), the relatively tight BP control in both arms might have contributed to the low event rate. The protein excretion rate decreased in the ARB arm and increased in the placebo arm, but this difference may have been influenced by the different achieved BP levels (Supple- mentary Tables 61 62 online). A large Canadian RCT of ramipril versus placebo is It will enroll 528 kidney-transplant patients who underwent transplantation 46 months previously, have protein excretion of 40.2 g per 24 hours, and have a GFR . Outcomes will include doubling of SCr level, kidney failure, and death. Because no large studies with clinically important out- comes have been completed, we have chosen to follow the recommendations of the KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients292 and to provide an ungraded statement. RESEARCH RECOMMENDATIONS RCTs are needed to determine: K The optimal target BP for adult patients with kidney transplants with a focus on clinically important outcomes such as graft survival, CVD, and mortality. 