Why are blockers of the renin angiotensin system preferred in individuals with diabetic nephropathy

Why are blockers of the renin angiotensin system preferred in individuals with diabetic nephropathy?

ACE inhibitors and ARBs are the preferred antihypertensive therapy in those with greater than 300 mg of albuminuria a day from diabetes. Such agents slow the progression of chronic kidney disease (CKD) more than other medication classes despite similar reductions in BP.

Clinical trials in patients with Stage 3 and 4 CKD evaluating these agents in both type 1 and type 2 diabetes demonstrated greater slowing than conventional BP-lowering therapy. While there is slightly more evidence for ARB than ACE inhibitor therapies, their efficacy is felt to be related to a similar mechanism of action, so that agents from each class are considered therapeutic equivalents.

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