Beyond Blood Pressure Control: Targeting Proteinuria with Renin-Angiotensin-Aldosterone Inhibitors

Aliskiren is an oral renin inhibitor recently approved for marketing in the U.S. In the Aliskiren in the Evaluation of Proteinuria in Diabetes (AVOID) trial, a double-blind, randomized, placebo-controlled study sponsored by the manufacturer of aliskiren, investigators explored whether combining aliskiren with losartan, an angiotensin-receptor blocker, would be renoprotective in patients with type 2 diabetes. After a 3-month, open-label run-in period, patients with type 2 diabetes, hypertension, and proteinuria who were receiving losartan (with or without other antihypertensive agents that do not block the renin-angiotensin-aldosterone system) were assigned to receive additional aliskiren (150 mg/day for 3 months, 300 mg/day thereafter) or p…