The incidence of stroke is elevated among individuals with kidney disease. Traditional risk factors seem to account for much but not all of this excess risk. Blood pressure control is the most important aspect of stroke prevention. Multiple classes of antihypertensive agents, including diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers, have reduced stroke risk. Some physiologic and clinical evidence suggests that angiotensin II receptor blockers may offer superior benefit to that of angiotensin-converting enzyme inhibitors for the same level of blood pressure control; however, few head-to-head trials have compared these two agent classes directly using stroke as an outcome.