In mortality terms diabetic nephropathy is the most important microvascular complication of diabetes. Even a small elevation in urinary albumin loss (microalbuminuria) is an independent predictor of end-stage renal failure (ESRF) and death. Detection, confirmation and treatment of diabetic nephropathy are mandatory aspects of diabetes care. Over the last decade a considerable body of evidence has built up suggesting that angiotensin-converting enzyme (ACE) inhibitors are superior to other antihypertensive agents in terms of both renal and overall vascular protection. More recently a number of important studies have reported the beneficial effects of angiotensin receptor antagonists (AIIA) in patients with type 2 diabetes at the stages of microalbuminuria and proteinuria. To date no large studies have directly compared ACE inhibitors with AIIA in patients with diabetic nephropathy. However, given the current state of knowledge, evidence-based therapeutic decisions are possible for individual patients with diabetic nephropathy.
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