Low Dose Versus Aggressive Inhibition of the Renin-Angiotensin-Aldosterone (RAS) to Treat Microalbuminuria

Inclusion Criteria: * Males and females, age 18-70 * Subjects with diabetic renal disease as defined by spot urine albumin - creatinine ratio 30-300mg/g and estimated glomerular filtration rate of \>60 ml/min Exclusion Criteria: * Intake of non-steroidal anti-inflammatory agents (NSAIDs) more than 15 days/month, excluding aspirin. * Inability to discontinue NSAIDs or aspirin for 5 days prior to GFR measurement. * History of severe adverse reaction to any of the randomized drugs required for use in the protocol or contraindication of their use. * Participation in another intervention study. * Pregnancy or likelihood of becoming pregnant during the study period; lactation * Clinical and laboratory evidence of any renal disease other than diabetic nephropathy. * History of drug abuse in the past 2 years, including narcotics, cocaine or alcohol (\> 21 drinks per week). Serious systemic disease that might influence survival or the course of renal disease. (Chronic oral steroid therapy is exclusion, but steroid-containing nasal sprays are not. Inactive sarcoidosis is not an exclusion). * History of malignant or accelerated hypertension within 6 months prior to study entry; previous chronic peritoneal or hemodialysis or renal transplantation. Known secondary causes of hypertension. Spot urine albumin - creatinine ratio exceeding 300 (mg/g) * Serum potassium level \> 5.5 mEq/L for those not on ACE inhibitors during Baseline, or serum potassium level \> 5.9 mEq/L for those on ACE i…