Background: Beneficial effect in reducing microalbuminuria of diabetic nephropathy with angiotensin converting enzyme (ACE) inhibitor and angiotensin II receptor blockers (ARB) is proven. This study has directly compared the renoprotective effects of ARB and ACE inhibitors in persons with type-2 diabetes.Methods: In this prospective, double-blind, controlled trial, 100 patients with type 2 diabetes mellitus were chosen and randomly assigned to either receive ACE inhibitor (ramipril 5 mg, 50 patients) or ARB (losartan 50 mg, 50 patients). The endpoint was a reduction in 24 hrs urine microalbuminuria after a period of 3 months treatment. Results: At the end of 3 months treatment, the mean reduction of 24 hrs urine microalbuminuria in the ramipril group was 25 mg as compared to 38 mg in the losartan group; (t value=1.11, p=0.27). There was no statistical difference in the mean reduction when compared between the two groups. Significant reduction of blood pressure especially systolic blood pressure was noted in the losartan group as compared to those who received ramipril.Conclusion: Losartan was not inferior to ramipril in providing renoprotection in subjects with type 2 diabetes and early nephropathy. Losartan showed a significant reduction in systolic blood pressure, though not much reduction was seen with ramipril. Despite this, both drugs have shown a reduction in microalbuminuria, which supports the fact that reduction in microalbuminuria is independent of the antihypertensive action of ramipril or losartan
