A elderly patient presents with hypeension and diabetes , proteinuria without renal failure. Antithypeensive of choice is

Ref Harrison 19 th ed pg 1625 In patients with type 2 diabetes, treatment with an ACEI, an ARB, or aliskiren decreases proteinuria and delays the progres- sion of renal disease. In experimental models of hypeension and diabetes, renal protection with aliskiren is comparable to that with ACEIs and ARBs. However, in patients with type 2 diabetes, addition of aliskiren to an ACEI provides no additional protection against cardiovascular or renal disease and may be associated with more adverse outcomes. Among African Americans with hypeension- related renal disease, ACEIs appear to be more effective than beta blockers or dihydropyridine calcium channel blockers in slowing, although not preventing, the decline of glomerular filtration rate. The renoprotective effect of these renin-angiotensin blockers, com- pared with other antihypeensive drugs, is less obvious at lower blood pressures.