Treatment of type 2 diabetic nephropathy by blockade of the renin-angiotensin system: a comparison of angiotensin-converting-enzyme inhibitors and angiotensin receptor antagonists.

Type 2 diabetes is the most prevalent form of diabetes mellitus worldwide and associated diabetic nephropathy is the most common cause of end-stage renal disease in the USA. Lowering blood pressure and controlling glucose slows the progression to end-stage renal disease or death. Although angiotensin-converting-enzyme inhibitors reduce proteinuria, their effects to slow progression to end-stage renal disease have not been clearly demonstrated in type 2 diabetic nephropathy. Recent clinical trials with angiotensin AT(1) receptor antagonists demonstrate that they reduce proteinuria, stabilize renal function and slow the progression of nephropathy to end-stage renal disease in patients with type 2 diabetes. These are significant benefits beyond those associated with conventional therapy and blood pressure control.