ACE and diabetes mellitus: Based on the ALTITUDE study results, dual aliskiren with ACE inhibitor/ARB therapy is now contraindicated by the US Food and Drug Administration in patients with diabetes and is to be avoided in patients with moderate renal impairment (GFR < 60 ml/min) [120], and is contraindicated by the European Medicines Agency (EMA) in patients with diabetes and in patients with moderate renal impairment (GFR < 60 ml/min) [121].