About 40 percent of type 1 and 70 percent of type 2 diabetic patients with normoalbumunuria have blood pressure levels > 140/90 mmHg (Zelmanovitz 2005). In the UKPDS, a reduction from 154 to 144 mmHg on systolic blood pressure reduced the risk for the development of microalbuminuria by 29 percent (Zelmanovitz 2005). Blood pressure targets for patients with diabetes are lower, 130/80 mmHg, than those for patients without diabetes (Zelmanovitz 2005). In the Hypertension Optimal Treatment (HOT) study, a reduction of diastolic blood pressure from 85 to 81 mmHg resulted in a 50 percent reduction in the risk of cardiovascular events in diabetic but no nondiabetic patients (Zelmanovitz 2005).

             The role of ACE inhibitors in the prevention of diabetic nephropathy in patients with type 1 diabetes has not been defined (Zelmanovitz 2005). The use of perindopril during 3 years in normotensive normoalbuminuric type 1 diabetic patients delayed the increase in albuminuria, and in patients with type 2 diabetes, ACE inhibitors and ARBs both diminish the risk for diabetic nephropathy and reduce the occurrence of cardiovascular events (Zelmanovitz 2005). In the MICRO-HOPE (Heart Outcomes Prevention Evaluation) study,10 mg/day of ramipril decreased the risk of overt nephropathy by 24 percent and the risk of cardiovascular heath in patients with type 2 diabetes who were 55 years of age with one additional cardiovascular risk factor by 37 percent (Zelmanovitz 2005). .

             Ramipril also reduced UAE at 1 year and at the end of the study (Zelmanovitz 2005). .

             In microalbuminuric type 1 and type 2 diabetic patients, numerous studies have shown that treatment of hypertension, irrespective of the agent used, produced a beneficial effect on albuminuria (Zelmanovitz 2005). Renin-angiotensin system (RAS) blockade with ACE inhibitors or ARBs confers an additional benefit on renal function, this effect is independent of blood pressure reduction and may be related to decreased intraglomerular pressure and passage of proteins into the proximal tubule (Zelmanovitz 2005).