If a diabetic patient has good control of diabetes (with or without medication), has “normal” blood pressure (< 130/80 mm Hg) and has no evidence of microalbuminuria (checked on 2 to 3 occasions), then there’s no indication for an ACE inhibitor for renoprotection. Having said that, the landmark 1999 HOPE study (NEJM 2000;342:145-53), 2000, which showed broad cardiovascular survival benefits for ACE inhibitors in a range of at-risk patients, yielded particularly promising results in the diabetic subgroup. So depending on the patient’s age (HOPE subjects were 55+ and averaged 66), there’s a strong argument that diabetic patients, and especially those with history of CVD or other CV risk factors, would benefit from an ACE inhibitor for cardiovascular protection.

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