There are, however, data from RCTs speci cally in those with severely increased albuminuria (A3), statistically pow- ered for kidney outcomes comparing speci c antihypertensive drugs to placebo or active comparators. Those trials included people with and without high BP, apart from a few studies that excluded people with normal BP.98,162 There are also secondary analyses of subgroups based on level of albumin- , comparing speci c antihypertensive drugs to placebo or to active com- parators from CV and kidney outcome trials. In RCTs of primary hypertension examining the effect of antihypertensive drugs on CV outcomes that included partici- pants with CKD, CV bene ts have been most consistent with ACEi, ARBs, thiazide-like diuretics, and CCBs. The data are less consistent with beta-blockers, which have been inferior to these above classes in some but not all trials and in many meta- analyses. However, beta-blockers are often indicated for spe- ci c conditions, such as angina pectoris, post-MI, and systolic heart failure with reduced ejection fraction (HFrEF). For CV disease prevention in those with high BP, unless there is a strong indication for 1 speci c class, it seems reasonable to begin with 1 or more drugs among ACEi or ARB, CCB, and thiazide-like diuretic. Non-dihydropyridine CCBs have the apparent addi- tional bene t of reducing proteinuria.170 If a 3-drug combina- tion of RASi, CCB, and diuretic at recommended doses is not adequate to control BP, additional therapy including a mineralocorticoid-receptor antagonist (MRA), long-acting alpha antagonist, or beta-blocker can be used, as well as dihy- dralazine, hydralazine, minoxidil, or centrally acting agents.171 Higher BP due to uid overload is common in CKD; therefore, diuretics are, in general, logical agents at appropriate dose to lower high BP, with or without the concomitant use of RASi. 