Table 1 Studies comparing the effect of ARBs and ACE inhibitors for kidney disease and cardiovascular outcomes in patients with chronic kidney disease

Trialists collaboration 

(Meta-analysis of 119 RCTs with ACE inhibitors and ARBs)

Kidney Disease and Cardiovascular Outcomes in patients with CKD

• ACE inhibitors reduce risk of kidney failure by 39% and ARBs by 30% (OR 0.61 (95%CI 0.47–0.79, OR 0.70 95%CI 0.52–0.89) respectively compared to placebo. ACE inhibitors and RBs reduced risk of cardiovascular outcomes by 35% and 25% respectively compared to active controls, while the active controls did not show significant evidence of renal benefits.

• Both ACE inhibitors and ARBs reduce the likelihood of major cardiovascular events with OR 0.82 (95%CI 0.71–0.92) and 0.76 (95%CI 0.62–0.89) respectively versus placebo. ACE inhibitors but not ARBs showed a significant reduction in all-cause mortality compared to active controls (OR 0.72 95%CI 0.53–0.92).

Strippoli et al

(Cochrane Systematic Review of 49 studies with 12,067 patients)

All-cause mortality and Kidney Disease Outcomes (progression of albuminuria)

• There was no significant difference in all-cause mortality for ACE inhibitors versus placebo (RR 0.91, 95%CI 0.71 to 1.17) or ARBs versus placebo (RR 0.99, 95%CI 0.85 to 1.17).

• A reduction in all-cause mortality risk was found with maximum tolerable doses of ACE inhibitors compared to half-doses (RR 0.78, 95%CI 0.61 to 0.98).

• Mortality was similar in studies with ACE inhibitors and ARBs. Renal effects (prevention of albuminuria progression) were similar between groups.