In patients with stable coronary disease in the Prevention of Events with Angio- tensin-Converting Enzyme Inhibitor Therapy (PEACE) trial, the ACE-I trandolapril, as compared with placebo, reduced mortality in those with a GFR o60 ml/min/1.73 m2 , although trandolapril did not have a benefit in those with However, the effect of trandolapril therapy on outcomes was not significantly modified by the level of albuminuria.188 In the European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease (EUROPA), there was no modification of benefit by level of kidney function, and perindopril (versus placebo) decreased the risk of the primary composite end point of cardiovascular death, non- fatal myocardial infarction, or resuscitated cardiac arrest in as well as those ALLHAT, however, did not show a benefit of lisinopril over chlorthalidone with respect to CVD outcomes in the subgroup of patients with The Prevention of Renal and Vascular Endstage Disease Intervention Trial (PREVEND IT) included CKD patients with urine albumin levels of 15 mg to 300 mg per 24 hours. Patients were randomized to the ACE-I fosinopril or placebo. Fosinopril decreased albumin excretion by 26% and showed a trend toward reducing the risk of CVD outcomes (hazard ratio [HR] versus placebo 0.60; 95% CI Similarly, in the CASE J trial, candesartan reduced the rate of CVD outcomes, as compared with amlodipine, in CKD 4 patients178 (Supplementary Table 5 online). The Work Group suggests ACE-Is or ARBs as the preferred class of BP-modifying agent in CKD patients with microalbuminuria. This recommendation is based on observational data and subgroup and post hoc analyses, hence the grade of 2D. 