Two large, multinational trials in overt nephropathy of type 2 diabetes found that interruption of the renin angiotensin system (RAS) with angiotensin II receptor blockers (ARBs) reduces the incidence of ESRD by about 30%, but has no appreciable effects on cardiovascular mortality. On the basis of these findings, ARB therapy has become standard treatment of patients with type 2 diabetes and nephropathy. However, despite ARB treatment, about 7% of patients continue to progress to ESRD and 7% continue to die every year.