Reviewing the benefits of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in diabetic nephropathy--are they drug specific or class specific?

Hypertension is prevalent in patients with type 2 diabetes mellitus and contributes to substantial morbidity and mortality. Preventing microalbuminuria (MAU) is important in these patients because MAU is associated with an increased risk of end-stage renal disease and cardiovascular events. Current hypertension treatment recommendations are based on drug 'class' effects. For the treatment of hypertension in patients with diabetes, important agent-specific effects should be brought into consideration in the choice of drug. For these patients, and especially in the presence of kidney disease, the choice of agent must effectively target not only blood pressure reduction, but also prevention and treatment of MAU for optimal organ outcomes. A review of the current evidence suggests a diversity of MAU-associated risk reduction according to agent within the angiotensin receptor blocker and angiotensin-converting enzyme inhibitor classes, ranging from nonefficacy to significant efficacy. Recommendations should clearly state absolute risk reduction according to agent, based on the best available evidence.