What are the indications for treatment with angiotensin-converting enzyme (ACE) inhibitors in patients with diabetes?

Tight control of hypertension treatment is key in preventing the vascular complications of diabetes. ACE inhibitors appear to have a protective effect that is independent of their antihypertensive effect. Unless there is a contraindication, all patients with diabetes who have hypertension should be treated with ACE inhibitors. Patients with diabetes who have microalbuminuria should be treated with ACE inhibitors, even if normotensive, as should those with overt nephropathy. (Grade of recommendation: A, based on randomized controlled trials.