Chronic Kidney Disease There has been a steady increase in the prevalence of CKD, defined as kidney damage, documented by kidney biopsy or serum markers for 3 months, or a decrease in glomerular filtration rate to <60 mL min 1 Kidney failure, defined as a glomerular filtration rate of <15 , and end-stage renal disease, which neces- sitates the initiation of treatment by replacement therapy,22 afflicts >525000 patients in the United States, 65% of whom are on long-term hemodialysis.56 Hypertension represents a major independent risk factor for renal failure, with a preva- lence of 28% in hypertensive patients.56 In patients with CKD, cardiovascular death is more likely than progression to end- stage renal disease, and in patients with end-stage renal dis- ease, CVD is the leading cause of death, being 5 to 30 times higher in patients on dialysis than in the general population.57 Even in patients with lower stages of CKD, the risk of CVD is increased independently of other risk factors, and even the smallest degree of albuminuria increases risk for CVD and all- In this patient population, hypertension itself is a leading cause of renal failure. BP goals in patients with CKD and microalbuminuria are lower than in the general popula- with a target the same as that in patients with estab- lished CAD. Recent investigations have demonstrated that standard treatments for cardiovascular risk factors, including statin therapy, ACE inhibitors, ARBs, and antiplatelet agents, are equally effective at risk reduction in patients with CKD (who are not on dialysis) as in those without CKD and should be offered to this patient population.59 In these patients, the serum potassium concentration should be monitored fre- quently. 