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. Patients had varying levels of albu- With relatively few events for the individual there was a 29% risk reduction (HR: 0.71; 95% CI: 0.58 0.87) for the composite outcome of CV events and CV mortality based on data from 1 study with 912 CKD participants and a mean follow-up of 21 months (Supplementary Table S17192 195 ). Quality of evidence. The overall quality of the evidence for kidney outcomes comparing ACEi or ARB with placebo or standard of care in patients with CKD and moderately increased albuminuria without diabetes is low, due to imprecision because of a lack of data. The quality of the ev- idence for CV outcomes in patients with A2 without diabetes was rated as low. HOPE provided indirect evidence, as only two-thirds of the population had no diabetes. Values and preferences. In the opinion of the Work Group, many well-informed patients would place more emphasis on the potential for preventing CKD progression. Resource use and costs. When treating patients with CKD (G1 G4, A2) where the indication for ACEi or ARB therapy is not strong, consideration should be given to the clinical impact on the patient and the costs of starting RASi, including additional clinic visits and the need for additional lab testing Considerations for implementation. There is insuf cient in- formation to differentiate between men and women for this recommendation. 