Recommendation 8 is specifically directed at those with CKD and hypertension and addresses the potential benefit of specific drugs on kidney outcomes. The AASK study showed the benefit of an ACEI on kidney outcomes in black patients with CKD and pro- Additional trials that support the benefits of ACEI or ARB therapy did not meet our inclusion criteria because they were not re- stricted to patients with hypertension.35,36 Direct renin inhibitors arenotincludedinthisrecommendationbecausetherewerenostud- ies demonstrating their benefits on kidney or cardiovascular out- comes. Thepanelnotedthepotentialconflictbetweenthisrecommen- dation to use an ACEI or ARB in those with CKD and hypertension and the recommendation to use a diuretic or CCB (recommenda- tion 7) in black persons: what if the person is black and has CKD? To answerthis,thepanelreliedonexpertopinion.Inblackpatientswith CKD and proteinuria, an ACEI or ARB is recommended as initial therapy because of the higher likelihood of progression to ESRD.21 In black patients with CKD but without proteinuria, the choice for initialtherapyislessclearandincludesathiazide-typediuretic,CCB, ACEI, or ARB. If an ACEI or ARB is not used as the initial drug, then an ACEI or ARB can be added as a second-line drug if necessary to achieve goal BP. Because the majority of patients with CKD and hy- pertension will require more than 1 drug to achieve goal BP, it is an- ticipatedthatanACEIorARBwillbeusedeitherasinitialtherapyor as second-line therapy in addition to a diuretic or CCB in black pa- tients with CKD. CKD, but there is no evidence to support renin-angiotensin system inhibitor treatment in those older than 75 years. Although treat- ment with an ACEI or ARB may be beneficial in those older than 75 years, use of a thiazide-type diuretic or CCB is also an option for in- dividuals with CKD in this age group. 