Angiotensin converting enzyme inhibitors (ACEi) were found to be effective for the primary prevention of kidney disease in patients with diabetes

Twenty to sixty percent of diabetic patients are affected by hypertension and antihypertensive agents are used to treat this condition. These agents are also used to prevent the onset of kidney disease both in normotensive and hypertensive diabetics. Twenty to 40% of patients with diabetic kidney disease progress to end-stage renal disease (ESRD) while the rest may die from associated coronary artery disease or other cardiovascular causes before the onset of ESRD. This study was undertaken to determine the benefits and harms of antihypertensive treatment in patients with diabetes but who do not show signs of kidney disease. Sixteen trials (7603 patients) were identified comparing antihypertensive agents to placebo, no treatment and other antihypertensive agents. ACEi significantly reduced the development of urinary protein (a sign of kidney damage) compared to other agents, but did not reduce all-cause mortality. More trials are needed that report the affect of antihypertensive agents on the prevention of kidney disease in diabetic patients.