Efficacy of ACE Inhibitors, MRAs and ACE Inhibitor/ MRA Combination

Inclusion Criteria: * Adult male and non-pregnant female patients with established diagnosis of type 2 DM at least five years ago with glycosylated hemoglobin (HbA1c) ≤ 8.5% * Age 30-80 Y * Stage 1 hypertension (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) and microalbuminuria diagnosed by measuring Urinary albumin/creatinine ratio (UACR) . Microalbuminuria was defined at a level between (30-300 mg/g) * Patients included in our study had never been treated with ACEIs, ARBs or aldosterone antagonists, serum potassium level ≥ 3.5 and ≤ 5.0 mmol/L before randomization with estimated glomerular filtration rate (e GFR) ≥50 mL/min/1.73 m2 Exclusion Criteria: * Patients with type 1 diabetes mellitus * Patients with BP ≥ 160/100 mmHg * Patients with secondary hypertension * Non-diabetic nephropathy including (chronic glomerulonephritis, polycystic kidney disease and nephrosclerosis), * Confirmed bilateral renal artery stenosis or stenosis of the renal artery in solitary functioning kidney * History of New York Heart Association functional class III and IV heart failure * Patients with rapid progression of kidney disease and women who were pregnant, breast-feeding, or planning to become pregnant during the study period