ACE Inhibitors vs. ARBs in Patients with Diabetic Nephropathy: A New Study

Head-to-head comparisons between angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) are needed for patients with diabetic nephropathy. In this randomized, double-blind European trial, researchers compared the ACE inhibitor enalapril (up to 20 mg daily) and the ARB telmisartan (Micardis; up to 80 mg daily) in 250 hypertensive patients with type 2 diabetes. Although all patients had early nephropathy (82% with microalbuminuria and 18% with macroalbuminuria), their serum creatinine levels were lower than 1.6 mg/dL, and their glomerular filtration rates (GFRs) were greater than 70 mL/min/1.73m². The maker of telmisartan supported the study.

During 5 years of follow-up, the mean decline in GFR was 18 mL/min/1.…