In this guideline, ACE-Is and ARBs are recommended for specific groups of CKD patients with increased urinary albumin excretion in which context use of these agents may be associated with and cardiovascular outcomes.97 In non-CKD patients, these drugs are indicated for the treatment of heart failure and for use soon after myocardial infarction, stroke, and in patients with high cardiovascular risk.98 100 The Oregon Health Resources Commission reported in 2005 on the use of ACE-Is in essential hypertension. No differences were found among various ACE-Is in terms of the BP-lowering effect and serious complications which were independent of gender, age, or African-American heritage.99 In 2006, the Commission reviewed the evidence for the use of It reported that there were no data to suggest that any particular ARB was superior to another in the context of a variety of clinical scenarios, including essential hypertension and high cardiovascular risk; nor was there evidence of any ARB being associated with a higher risk of serious complica- tions or differences in efficacy or side effects regardless of age, race, or gender. In reviewing studies specifically involving patients with CKD, no important differences in the effect of ARBs on BP or side effects were found. Accordingly, ACE-Is or ARBs might be considered for use in patients with CKD who have heart failure, recent myocardial infarction, a history of stroke, or a high cardiovascular risk. However, it is not possible to make any recommendations for CKD patients in particular, since the data are largely from studies of non-CKD patients. In addition, because CKD patients are at higher risk of side effects, particularly hyperkalemia and reduction in GFR, the use of ACE-Is or ARBs may not have the same risk-to-benefit ratio in CKD patients as in non-CKD populations. Drug combinations. 