Large-scale randomized trials evaluating the nephro- and cardio-protective effects of RAS inhibition with angiotensin-converting enzyme (ACE) inhibitors in overt nephropathy of type 2 diabetes are missing. However, studies in patients with type 1 diabetic nephropathy showed that ACE inhibitor therapy may decrease progression to ESRD by 40% and cardiovascular mortality by about 50%. Similar studies in non diabetic chronic nephropathies. consistently found a 40-50% reduction in the risk of progression to ESRD with ACE inhibitors as compared to non-RAS inhibitor therapy. Moreover, a meta-analysis of studies including type 2 diabetic patients with different degree of renal involvement showed that ACE inhibitors and ARBs sheared a similar renoprotective effect, but only ACE inhibitors significantly decreased the cardiovascular mortality.