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Aliskiren (Tekturna), a direct renin inhibitor, was FDA-approved in 2007 for treatment of hypertension. Researchers conducted this industry-sponsored randomized trial to determine whether dual blockade of the renin-angiotensin-aldosterone system — with the combination of aliskiren and the angiotensin-receptor blocker losartan — reduces proteinuria in patients with diabetic nephropathy. The trial involved 599 patients with type 2 diabetes, hypertension, and nephropathy (urinary albumin-to-creatinine ratio between 300 and 3500 mg/g). Patients with glomerular filtration rate (GFR) <30 mL/min or serum potassium >5.1 mEq/L were excluded.
Patients received either losartan plus aliskiren or losartan plus placebo. At 6 months, the mean urinary album…