ACE Inhibitor, ARB, or Both in Diabetic Renal Disease?

Some clinicians prescribe combinations of angiotensin-converting–enzyme (ACE) inhibitors plus angiotensin-receptor blockers (ARBs) for patients with type 2 diabetes, on the premise that dual blockade of the renin–angiotensin system will slow progression of diabetic nephropathy more effectively than single-agent therapy. In this study, researchers randomized 133 type 2 diabetic patients with nephropathy to receive lisinopril (titrated to 40 mg daily), irbesartan (titrated to 600 mg daily), or combined therapy (titrated to 20 mg and 300 mg, respectively). Inclusion criteria included stage 2 or 3 kidney disease and urine protein-creatinine ratio >300 mg/g. At baseline, mean blood pressure was 153/81 mm Hg, and mean serum creatinine level was 1…