[140] The AASK trial would suggest that African Americans with CKD should be placed on an ACEI, but the ALLHAT study reported that chlorthalidone was superior to lisinopril for CVD outcomes in African Americans.[141] Therefore, for African American patients with CKD on monotherapy with an ACEI or an ARB, the addition of a thiazide-type diuretic would be appropriate as additional therapy to augment the cardiovascular protection of diuretics to the kidney protection of ACEIs or ARBs. Providers may refer to the VA/DoD Clinical Practice Guideline for the Management of Chronic for further discussion of use of an ACEI or ARB in patients with CKD. In addition, the potential for increased risk of AEs with blood pressure medication was a concern noted among the participants in the patient focus group. Although not included in the previous evidence review, the Work Group noted the potential for harm with an ACEI in African American patients due to an increased risk for angioedema reported to be up to five times greater than in white patients. Of the patients randomized to an ACEI in ALLHAT, angioedema was reported as a serious adverse event more frequently in the subgroup of African American patients (0.72%) compared to non-African American patients (0.31%), and more frequently than African American patients receiving treatment with a thiazide- type diuretic (0.04%) or a LA DHP CCB (0.06%).[136] Per FDA product information, angioedema has been reported rarely in patients treated with an ARB. Additional research is needed to determine the risk in African American patients and/or patients who have previously experienced angioedema while on an ACEI. Additional considerations include potential compelling indications for use of an ACEI or ARB in patients with HTN and comorbidities. 