Single and Twice-daily Dosing of Ramipril on Renal Function in Chronic Kidney Disease Patients With Reduced Ejection Fraction Heart Failure

This study is comparing taking the blood pressure medication ramipril (an ACE inhibitor) once daily versus twice daily in patients who have both chronic kidney disease (CKD) and heart failure with reduced pumping ability, to see which dosing schedule better protects kidney function. **You may be eligible if...** - You are over 18 years old - You have been diagnosed with moderate-to-severe CKD (stage 3–5, not yet on dialysis) - You also have heart failure with reduced ejection fraction (heart pumping below 40%) **You may NOT be eligible if...** - You are currently on dialysis - You have had a serious allergic reaction (angioedema) to ACE inhibitors - You are pregnant - You have dangerously high potassium levels that cannot be controlled - You are taking ARBs or sacubitril-valsartan (Entresto) - Your blood pressure is very low (below 90/60) Talk to your doctor to see if this trial is right for you.