OBJECTIVES: Angiotensin Receptor Blockers (ARBs) are indicated for the prevention and treatment of kidney disease in patients with Type 2 Diabetes Mellitus (T2DM), with established efficacy for nephropathy outcomes. Randomized Controlled Trials (RCTs) have also shown the benefit of using ARBs on cardiovascular outcomes in patients with T2DM. Results from the ROADMAP trial raised concerns of increased risk of cardiovascular death with olmesartan. Currently available ARBs differ in terms of potency and surmountable versus insurmountable blockade; therefore, not all of them provide the same benefits and harms. In the absence of published direct comparative studies, however, an indirect comparison among these agents is necessary to inform clinical decision making. METHODS: A systematic literature search was conducted in PubMed and Cochrane Central Register of Controlled Trials through September 2011 for RCTs evaluating ARBs in patients with T2DM. Outcomes of interest were cardiovascular death, all-cause mortality, and cardiovascular morbidity and mortality. Outcomes were initially pooled using standard random-effects methods producing odds ratios (OR) and 95% confidence intervals (CI).  Adjusted indirect comparisons between agents using pooled estimates were then performed using Song’s method when a common comparator was available, typically a placebo. RESULTS: A total of 10,833 patients from 7 RCTs were analyzed. Compared to olmesartan, candesartan offered statistically significant protection against cardiovascular death (OR 0.14, 95%CI 0.03 - 0.72), while irbesartan trended towards protection (OR 0.22, 95%CI 0.05 - 1.02). No significant difference was found between candesartan and irbesartan in cardiovascular death (OR 0.64, 95%CI 0.31 to 1.34). No significant differences were found between any agents for all-cause mortality or cardiovascular morbidity or mortality. CONCLUSIONS:  Differences in outcomes may exist between ARBs in patients with T2DM, so head-to-head clinical trials are required to confirm the findings of this adjusted indirect comparison analysis.