Hypothesis: Reduction in urinary albumin by escalating dosages of an ARB or by combination therapy of ARB plus eplerenone can reduce residual renal and cardiovascular risk associated with ongoing albuminuria in patients with type 2 diabetes mellitus.
Inclusion criteria: Patients > 18 years old with type 2 diabetes mellitus on either an ACE inhibitor or ARB with a PCR of 500 mg/g to 1000 mg/g at enrollment.
Design: Patients with proteinuria between 500 mg and 1g per day and GFR 45-60 ml/min will be randomized in open-label fashion to 1 of 2 groups.
Follow-up: Patients continued on study protocol for 5 years
Primary Outcomes: Doubling of serum creatinine, ESRD or death
Secondly Outcomes: Composite of myocardial infarction, coronary revascularization, sudden death or stroke