Meta-analysis was conducted by the Cochrane Kidney and Transplant Evidence Review Team as part of the guideline evidence review. *Includes patients both with and without high blood pressure. CCB, calcium channel blocker; CI, con dence interval; CyP, cytochrome P450 3A5 polymorphism; M-H, Mantel-Haenszel. chapter 4 www.kidney-international.org higher; 95% CI: 2.79 higher 7.74 higher) compared to pla- cebo over a mean follow-up of 15.3 months (Supplementary ). The tradeoff or harms with these interventions include well-known adverse events for both dihydropyridine CCB ) and ARB (e.g., anemia, acute decline in kidney function, hyperkalemia336 ). The evidence review found that, compared to placebo or no treatment, ACEi, alpha-blockers, beta-blockers, and MRAs had no signi cant effect on mortality, graft loss, or CV events (Supplementary Table S35,332,337 349 Supplementary Table S36,350 Supplementary Table S37,351 Supplementary Table S38352 ). With regard to ACEi there was trial evidence showing that these agents were effective at reducing BP and proteinuria in kidney transplant recipients (Supplementary Table S35). However, there was no signi - cant effect of ACEi on all-cause mortality or graft loss, and their use was associated with a signi cant increase in adverse events in the kidney transplant population, including angioedema, cough, hyperkalemia, and anemia (Supplementary Table S35). Quality of evidence. The ERT updated a Cochrane sys- and evaluated the quality of the evidence based on RCTs only (Supplementary Tables S33 S39). The evidence for the use of an ARB or CCB compared to placebo or no treatment is considered low quality because of a serious risk of bias (unclear randomization sequence generation and allocation concealment) and imprecision around the effect estimates. Overall, there were very few graft failure events, which introduces greater fragility in the effect estimates. 