Treat hypertension early and aggressively. A reasonable goal is to aim for BP of 125/75-130/80mmhg.
ACE inhibitors are the preferred agents for lowering blood pressure. They are beneficial in decreasing proteinuria and should be strongly considered even in normotensive patients with proteinuria.
The decrease in proteinuria with ACE inhibitors may be an effect of decreasing the intraglomerular pressure and of changing the glomerular size selectivity.
Reports have demonstrated that ACE inhibitors are more effective than other antihypertensive drugs in slowing the progression of proteinuric renal disease.
The goal for proteinuria control is 500mg/day or less, so ACE inhibitors or ARBs should be started in patients with 24-hour urine protein of 500 mg or more.
One randomized, controlled trial followed patients for a mean of approximately 6 years. The group that received ACE-I had an improved renal survival rate compared to the group receiving other antihypertensive agents.