Strategies to delay progression of established renal disease have primarily been directed at examining the class of antihypertensive therapy and/or the level of blood pressure control. In diabetic renal disease many trials have noted a protective role of ACE inhibitor-based therapy over non-ACE inhibitor-based therapy. This paper reviews recent clinical trials evaluating hypertension-related kidney disease including the interim results of the African-American Study of Kidney Diseases and Hypertension (AASK) Study, to date the largest prospective study of African-American patients with kidney disease due to hypertension. This trial reports a renoprotective effect of ACE inhibitor-based therapy over calcium-channel antagonist- based therapy. The renoprotective effect of ACE inhibitor-based therapy may, in part, be due to their antiproteinuric effect independent of blood pressure lowering.