ACE inhibitors vs angiotensin receptor blockers (ARB)
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Clinical trials
systematic review of 43 trials randomized controlled trials of at least 6 months duration
- combined 43 trials involved 7545 patients with diabetic nephropathy
- 36 trials of ACE inhibitor vs placebo
- 4 trials of ARB vs placebo
- 3 trials of ACE inhibitor vs ARB
Results:
- mortality reduced significantly with ACE inhibitors (RR = 0.79), but not with ARBs (RR = 0.99)
- similar effects of ACE inhibitors & ARBs on end-stage renal disease & doubling of serum creatinine
- small sample size confounded direct comparison of ACE inhibitors with ARB
randomized, double-blind placebo-controlled trial
- 250 patients with diabetes mellitus type 2 with diabetic nephropathy
- 82% with microalbuminuria
- 18% with proteinuria
- all patients with serum creatinine < 1.6 mg/dL &
- GFR > 70 mL/min/1.73m2
enalapril (ACE inhibitor) up to 20 mg/day
telmisartan* (ARB) up to 80 mg/day
5 years of follow-up
Results:
- mean decline in GFR was 18 mL/min/1.73m2 with telmisartan & 15 mL/min/1.73m2 (not a significant difference)
- blood pressure control, changes in serum creatinine, microalbuminuria, end-stage renal disease & cardiovascular events were the same in the 2 groups
* study supported by manufacturer of telmisartan
ACE inhibitors vs ABS & the risk of dementia
- compared to an ACE inhibitor, initiation with an ARB is associated with reduced risk of incident all-cause dementia (RR=0.92) & vacular dementia (RR=0.87) but not Alzheimer disease[5]
References
- ↑ Journal Watch 24(23):173, 2004 Strippoli GF, Craig M, Deeks JJ, Schena FP, Craig JC. Effects of angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists on mortality and renal outcomes in diabetic nephropathy: systematic review. BMJ. 2004 Oct 9;329(7470):828. Epub 2004 Sep 30. Review. <PubMed> PMID: https://pubmed.ncbi.nlm.nih.gov/15459003 <Internet> http://bmj.bmjjournals.com/cgi/content/full/329/7470/828
- ↑ Journal Watch 24(23):174, 2004 Barnett AH, Bain SC, Bouter P, Karlberg B, Madsbad S, Jervell J, Mustonen J; Diabetics Exposed to Telmisartan and Enalapril Study Group. Angiotensin-receptor blockade versus converting-enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med. 2004 Nov 4;351(19):1952-61. Epub 2004 Oct 31. PMID: https://pubmed.ncbi.nlm.nih.gov/155166963)
- ↑ Prescriber's Letter 14(12): 2007 ACE Inhibitors Versus ARBs Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=231213&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Prescriber's Letter 15(6): 2008 ACE Inhibitors Versus ARBs Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240610&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 5.0 5.1 Cheung ECL, Adesuyan M, Szilcz M, et al. Antihypertensive drug classes and risk of incident dementia: a multinational population-based cohort study. Age Ageing. 2025 May 3;54(5):afaf121 PMID: https://pubmed.ncbi.nlm.nih.gov/40413804 PMCID: PMC12103899 https://pmc.ncbi.nlm.nih.gov/articles/PMC12103899/