A 2004 meta-analysis concluded that there was insufficient evidence on the relative effects of ACE-Is versus ARBs on survival.280 We were unable to find trials directly comparing ACE-Is and ARBs in patients with diabetes and albuminuria. No clear difference between the effects of the two classes of drugs was found in the large Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint (ONTARGET) trial involving people at high cardiovascular risk, including subgroups with diabetes or CKD.281,282 However, this study was not powered to make this comparison, so a real difference remains possible. The data are even more scarce regarding the effects of other drug classes on outcomes in patients with diabetes and proteinuria. In IDNT, patients with proteinuria were rando- mized to irbesartan, amlodipine, or placebo. Amlodipine did not significantly affect the risk of kidney or cardiovascular events as compared to placebo and was clearly inferior to irbesartan for the prevention of kidney outcomes.184 Aldoster- one antagonists can reduce the risk of proteinuria in non- diabetic CKD patients109,283 and in patients with diabetic but adequately powered studies are lacking. In the opinion of the Work Group, ACE-Is and ARBs are likely to be similarly effective in improving outcomes in patients with diabetes and proteinuria. Practitioners should therefore base prescribing decisions on the evidence available for each class, the risk of side effects, and cost considerations. RESEARCH RECOMMENDATIONS K Prospective RCTs of a risk-based approach to the reduction of cardiovascular risk and kidney end points are encouraged. K Studies comparing various BP intervention thresholds and targets among patients with diabetes, with or without an increased urinary AER, and with or without a reduced GFR are needed. K Studies in which drug dose is titrated on the basis of the urine albumin level (or change in GFR) are needed. 