What is the optimal dosing of lisinopril for renal protection in normotensive patients with diabetes and moderate albuminuria (30–299 mg/d)?

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EVIDENCED-BASED ANSWERLisinopril dosed at least 10 mg daily decreases risk for progression from micro- to macroalbuminuria in patients with cardiovascular risk factors including diabetes (SOR: B, meta-analysis of RCTs). In insulindependent patients with microalbuminuria, lisinopril 10 to 40 mg daily (titrated to lower diastolic pressures <75 mmHg) decreases albumin excretion rates (SOR: C, extrapolated from an RCT in which patients had normal-range blood pressures and modest systolic hypertension).

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