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Correspondence
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Volume 361:1410-1411 October 1, 2009 Number 14
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Renal and Retinal Effects of Enalapril and Losartan in Type 1 Diabetes

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by Mauer, M.
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To the Editor: Mauer et al. (July 2 issue)1 used structural hallmarks of diabetic renal disease to show that early blockade of the renin–angiotensin system did not slow progression of type 1 diabetic nephropathy. The study excluded patients whose blood pressure was greater than 135/85 mm Hg. This may have had a major effect on study outcome. First, not all patients with type 1 diabetes are at risk for the development of nephropathy. In contrast to retinopathy, diabetic nephropathy develops in less than 50% of patients with type 1 diabetes.2,3 Arterial hypertension clearly contributes to the predisposition for diabetic nephropathy.3 . . . [Full Text of this Article]



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