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ACE inhibitors have long been indicated as first-line treatment to attenuate renal dysfunction in patients with diabetes, and angiotensin-receptor blockers (ARBs) also are now indicated. Which is better?
European researchers did a head-to-head, randomized, double-blind comparison involving 250 patients with hypertension, type 2 diabetes, serum creatinine <1.6 mg/dL, and a glomerular filtration rate (GFR) >70 mL/minute/1.73 m2. Subjects received either enalapril (up to 20 mg daily) or telmisartan (up to 80 mg daily). All had BPs <180/95 mm Hg after at least 3 months of ACE-inhibitor therapy, body-mass indexes >25 kg/m2 upon diagnosis of diabetes, and glycosylated hemoglobin <12%. The maker of telmisartan funded the study.
About one third of su…