Are angiotensin inhibitors more renoprotective?
A consensus has emerged that angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) have specific renoprotective effects. Guidelines specify that these are the drugs of choice for the treatment of hypertension in patients with renal disease. JP Casas and colleagues sought to determine to what extent this consensus is supported by the available evidence in a metaanalysis of published studies.1 Electronic databases were searched through January 2005 for randomized trials assessing antihypertensive drugs and progression of renal disease. Doubling of creatinine and end-stage renal disease, and creatinine levels, albuminuria, and glomerular filtration rates, were calculated with random-effect models. The effects of ACE inhibitors or ARBs in placebo-controlled trials were compared with the effects seen in trials that used an active comparator drug. The authors concluded that the benefits of ACE inhibitors or ARBs for renal outcomes in placebo-controlled tr
