In the overall HOPE study, the CV bene ts of ramipril versus placebo were also present in those with moderately increased There were no studies speci cally evaluating the effect of RASi on slowing kidney disease progression in patients with CKD without diabetes and A2; therefore, HOPE provides the best guide for this subpopulation. Cinotti et al. examined the role of lisinopril on progression of kidney disease assessed by inulin clearance in 131 patients without diabetic nephropathy The mean baseline proteinuria perday was 506 mg, thusincluding A2and A3,and progression to dialysis or ESKD was reduced by 66% but with very wide 95% con dence intervals (HR: 0.34; 95% CI: 0.01 7.92). The TRANSCEND study compared telmisartan to placebo in high-risk patients with and without high BP. It reported a bene t of the ARB on the composite of doubling of serum creatinine or ESKD in those with moderately increased albuminuria, but detrimental kidney effects in those with normal or mildly increased albuminuria (P for interaction 0.006).198 Limitations of subgroup data on ter- tiary outcomes with low event numbers apply. There is sparse evidence for agents other than RASi used as initial therapy for high BP in people with CKD and moderately increased albuminuria (A2) without diabetes. In the AASK trial (mean PCR approximately 0.33 g/g [33 mg/mmol]), meto- prolol and amlodipine were not signi cantly different from ramipril for the few CV events that occurred, but they were inferior to ramipril for clinical kidney outcomes for which the trial was powered.98 For MRAs, there were 3 RCTs with a total of 1426 par- ticipants mainly from HF, not hypertension, trials with de ned CKD subgroups. 