The results demonstrated improved precision with narrower con dence intervals than smaller meta-analyses reported below.169 Both ACEi and ARBs reduced the risk of kidney failure (de ned as a composite of any of the following: doubling of serum creatinine, 50% decline in GFR, or ESKD) by 39% and 30%, respectively, compared to placebo with high certainty; and 35% and 25%, respectively, against active controls with moderate certainty. Although both ACEi and ARB reduced major CV events to the same degree compared to placebo (18% for ACEi and 24% for ARB), ACEi, www.kidney-international.org chapter 3 compared to ARBs, were consistently associated with higher probabilities of reducing kidney failure and CV death. ACEi, but not ARB, reduced the odds of all-cause death compared to active control. Results of the network analysis were not sub- divided by diabetes or albuminuria status. Therefore, any antihypertensive treatment algorithm in CKD beyond monotherapy depends on expert opinion, pathophysiologic or pharmacodynamic considerations, extrapolation from ndings in primary hypertension in the absence of CKD, and small studies in CKD with surrogate outcomes, namely change in BP over the short term or meta- analyses of underpowered studies. In people with high BP and CKD, and mildly or moder- ately increased albuminuria (A1 or A2), there is limited evi- dence on CV or kidney outcomes from RCTs comparing speci c antihypertensive drugs to placebo or active compar- ators. There are, however, data from RCTs speci cally in those with severely increased albuminuria (A3), statistically pow- ered for kidney outcomes comparing speci c antihypertensive drugs to placebo or active comparators. 