Management of hypertension in people with kidney disease is challenging and generally requires at least three different and complementary acting antihypertensive agents to achieve the recommended blood pressure goal by the JNC VI and WHO guidelines of <130 5="" mmhg.="" this="" is="" also="" true="" for="" the="" recent="" blood="" pressure="" goal="" for="" diabetes="" of=""><130 0="" mmhg="" recommended="" by="" both="" the="" national="" kidney="" foundation="" and="" american="" diabetes="" association="" for="" reduction="" of="" cardiovascular="" risk="" and="" preservation="" of="" kidney="" function.="" commonly="" used="" combinations="" include="" an="" ace="" inhibitor,="" which="" has="" compelling="" indications="" for="" use="" in="" people="" with="" kidney="" disease="" with="" a="" diuretic,="" generally="" a="" thiazide="" type="" agent.="" angiotensin="" receptor="" blockers="" have="" clearly="" shown="" effectiveness="" for="" slowing="" nephropathy="" progression="" in="" type="" 2="" diabetes="" and="" clearly="" have="" a="" role="" as="" first-line="" agents="" in="" that="" disease.="" if="" additional="" therapy="" is="" required,="" either="" a="" beta="" blocker="" or="" calcium="" antagonist="" may="" be="" added="" to="" this="" antihypertensive="" 'cocktail'.="" beta="" blockers="" are="" particularly="" effective="" in="" people="" with="" a="" high="" sympathetic="" drive,="" i.e.="" high="" pulse="" rates,="" to="" lower="" pressure="" and="" reduce="" cardiovascular="" risk.="" moreover,="" in="" recent="" studies="" their="" benefits="" on="" kidney="" function="" both="" by="" reducing="" proteinuria="" and="" slowing="" decline="" of="" kidney="" function="" make="" them="" good="" agents="" to="" add="" in="" the="" appropriate="" clinical="" setting.="" given="" recent="" data="" from="" an="" analysis="" of="" the="" nhanes="" iii="" database="" showing="" only="" 11%="" of="" people="" being="" treated="" for="" hypertension="" with="" diabetic="" kidney="" disease="" have="" achieved="" the="" blood="" pressure="" goal="" of=""><130 5="" mmhg,="" it's="" no="" wonder="" the="" incidence="" of="" people="" starting="" dialysis="" continues="" to="" climb.="" physicians="" need="" to="" work="" harder="" and="" educate="" patients="" on="" the="" importance="" of="" achieving="" these="" lower="" blood="" pressure="">