Abstract
Patients with type 2 diabetes at high risk for cardiovascular disease who were already taking a renin–angiotensin system blocker were randomly assigned to the direct renin inhibitor aliskiren or placebo. The study was discontinued early for no benefit, or even possible harm.
Mortality associated with type 2 diabetes remains nearly twice that when diabetes is absent.
1
Complications of diabetes, particularly renal and cardiovascular disease, substantially increase the risk of subsequent severe illness and death. When a patient has both renal and cardiovascular disease, the risk is magnified further.
2
,
3
Blood-pressure lowering is beneficial in slowing renal-disease progression, reducing cardiovascular disease events, and preventing premature death.
4
Renin–angiotensin–aldosterone system (RAAS) blockers are highly effective, with apparent benefits extending beyond simple blood-pressure lowering
5
–
8
; such agents have become the preferred first-line interventions in high-risk persons with diabetes.
Theoretically, dual RAAS blockade should be more . . .