Table 2.

Antihypertensive Agents and Proteinuria Effect

Agents affecting RAAS	Proteinuric Effect
ACEI/ARB	Equally effective in reducing proteinuria and slowing DN progression56–58
Direct renin inhibit (aliskiren)	Comparable anti-proteinuria reduction to ACEI/ARB81
ACEI/ARB+direct renin inhibitor	Lower proteinuria by 20% more than monotherapy81
Aldosterone antagonists	Reduce proteinuria effectively82–93
ACEI/ARB+Aldosterone antagonists	Additive anti-proteinuric effect independent of BP control86,87,93
Agents not affecting RAAS	Proteinuric Effect
DHP CCB	Very effective BP control but inferior to RAAS blockade in reducing proteinuria95–102
NDHP CCB	Can reduce proteinuria. Some studies showing comparable anti-proteinuric effect to ACEI/ARB116–119
β-Blockers and diuretics	Inferior to RAAS and NDHP in reducing proteinuria but comparable in reducing decline in GFR124,126
Combination of RAAS±non-RAAS agents	Proteinuric Effect
ACEI+Diuretics	Greater proteinuric reduction but lesser BP reduction than ACEI+DHP CCB127
ACEI+DHP CCB	Better BP control but inferior in proteinuric control than ACEi+diuretics127