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Many clinicians believe that inhibition of the renin–angiotensin system prevents diabetic nephropathy. Similarly, researchers have hypothesized that such inhibition could prevent diabetic retinopathy. In this international randomized trial, investigators enrolled 285 normotensive patients with type 1 diabetes (mean glycosylated hemoglobin level, 8.5%; mean diabetes duration, about 11 years) and normal urine albumin levels. Patients received daily enalapril (an angiotensin-converting–enzyme inhibitor [ACE-I]; 20 mg), losartan (Cozaar, an angiotensin-receptor blocker [ARB]; 100 mg), or placebo; follow-up was 5 years. The primary endpoints were nephropathy (change in mesangial fractional volume, as measured by renal biopsy) and retinopathy (pr…