Only a few RCTs of BP agents have focused on CVD outcomes in subjects with CKD (Supplementary Tables 7 32 online); therefore, most of the data are from subgroup analyses of CKD patients from general population studies. Several analyses have shown a benefit of ACE-Is or ARBs over placebo or another agent, and although most of these studies were performed in patients with urine albumin levels below the macroalbuminuria cutoff, there is no obvious reason why the benefit would not extend to individuals with macroalbuminuria (Supplementary Tables 7 12 online). In summary, the data in support of the use of ACE-Is or ARBs are reasonably strong for preventing progression of CKD and less so for CVD protection. Notably, they show no harm of either class of drugs with regard to CVD. Taken together, the data on both drug classes support a grade 1B recommendation for ACE-Is or ARBs as a preferred agent in CKD patients with albumin excretion 4300 mg per 24 hours or its equivalent. RESEARCH RECOMMENDATIONS K Large RCTs of BP targets are needed in CKD patients without diabetes (stratified by GFR and albuminuria) that are powered for clinical outcomes including kidney failure, CVD events and mortality. K Large RCTs of BP agents are needed in CKD patients without diabetes (stratified by GFR and albuminuria) that are powered for clinical outcomes including kidney failure, CVD events and mortality. K Subgroup analyses in new, large-scale RCTs as described above by specific causes of CKD are needed. K Studies are needed to examine how intermediate out- comes for CKD and CVD (i.e., doubling of creatinine level, change in urine protein level, and development or regression of left ventricular hypertrophy) track with clinical outcomes to assess their validity as prognostic tools and possible surrogate outcomes going forward. 