This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. This is a pilot study to determine whether Carvedilol is superior to Metoprolol when used in combination with an ACE inhibitor in decreasing albumin excretion, and improving endothelial function in patients with diabetic nephropathy. At baseline and at the end of 12 weeks after randomization to either drug the following assessments will be made: 1. Albumin excretion rate; 2. Endothelial function. If this therapy is successful it will provide us with an additional way to use combination therapy to treat diabetic nephropathy in a population that is at high risk for cardiovascular disease and dialysis. The forearm blood flow studies will also give us further insight into whether type 2 diabetes in African-Americans is associated with endothelial dysfunction despite treatment with ACEIs and whether this dysfunction is related to a defect in nitric oxide production or action, and whether it is amenable to correction with drugs like Carvedilol.
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