The Renin-Angiotensin-Aldosterone System in Adiposity, Blood Pressure and Glucose in African Americans

Inclusion Criteria: * African Americans aged 18-65 years old with a history of impaired fasting glucose, impaired glucose tolerance, hemoglobin A1c 5.7-6.4% or other risk factors for diabetes including metabolic syndrome, family history of type 2 diabetes in the parents or siblings or history of gestational diabetes will be invited to attend a formal screening visit. Participants with impaired glucose tolerance defined as 2-hour plasma glucose 140-199 mg/dl after a fasting 75-g oral glucose tolerance test and who meet other enrollment criteria will be enrolled. Exclusion Criteria: * Type 2 Diabetes (American Diabetes Association Criteria) * Hypertension with systolic blood pressure (SBP) \> 150 mmHg or diastolic blood pressure (DBP) \> 100 mmHg or taking anti-hypertensive medications * SBP \< 100 mmHg or DBP \< 60 mmHg * Pharmacologic treatment with statins, β-Blockers, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, renin inhibitors, and/or mineralocorticoid antagonists * Steroid use * Hyperkalemia (Potassium \> 5.0 milliequivalent/L) * Abnormal renal function tests: Glomerular Filtration Rate calculated using the Chronic Kidney Disease Epidemiology Equation \< 60 ml/min/1.73 m² * Treatment with oral hypoglycemic medications, * Use of antipsychotic medications or severe psychiatric disorders (severe mental illness) Severe Psychiatric Disorders: * Schizophrenia * Paranoid and other psychotic disorders * Bipolar disorders (hypomanic, manic, depressive, and mixed) * Major depressive disorders (single episode or recurrent) * Schizoaffective disorders (bipolar or depressive) * Pervasive developmental disorders * Obsessive-compulsive disorders * Depression in childhood and adolescence * Panic disorder * Post-traumatic stress disorders (acute, chronic, or with delayed onset) * Bulimia Nervosa * Anorexia Nervosa * History of, or planned, bariatric surgery, * Weight loss \> 5% over the previous 6 months, * Pregnancy, planning to conceive a child in the next 9 months, or progesterone based contraception and unable to switch to non-progesterone based contraception, * Previous or current diagnosis of cardiac structural and functional abnormalities, history or current diagnosis of heart failure (New York Heart Association classes II-IV), history of myocardial infarction, coronary bypass surgery, or percutaneous coronary intervention during the 6 months prior to screening, * History of angioedema, or known hypersensitivity to study drugs.