The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was a large RCT examining the effects of the ACE-I lisinopril, the thiazide chlorthalidone, and the dihydropyridine calcium-channel blocker amlodipine in individuals 455 years of age with hypertension and at least one other CVD risk factor. Lisinopril did not show a benefit for doubling of creatinine or kidney failure when compared with chlorthalidone in the entire cohort or among patients with CKD at baseline175 (see Supplementary Table 6 online). ALLHAT, however, did not permit the use of an ACE-I with a diuretic a combination that is frequently required in clinical practice to achieve adequate BP control.182184 In addition, the diuretic arm in ALLHAT achieved better BP control making comparison of agents more difficult to interpret. Unfortunately, albuminuria or proteinuria status was not measured in the enrolled subjects, but assuming that ALLHAT was consistent with other trials of high-risk individuals recruited from the general population (e.g., HOPE or TRANSCEND), the median level of proteinuria was most likely below the microalbuminuria cutoff. CVD. There have been few RCTs of BP agents that have focused on CVD outcomes in CKD patients without diabetes mellitus (Supplementary Tables 7 32 online). Most of the data are taken from subgroup analyses of patients with CKD from general population studies (Supplementary Tables 1, 5 6, 33 36 online). 