Table 1 Renoprotective effects of ACE inhibitors and ARBs (large [n ~ or > 100] randomized controlled studies)

ACE inhibitor

IDDM patients with macroalbuminuria [17]

Captopril or placebo

48% RR in doubling of serum creatinine; 50% RR of the combined endpoint (death, dialysis and transplantation)

T2DM patients with albuminuria [43]

Enalapril or placebo

1% versus 13% decline in kidney function

Nondiabetic patients with proteinuria [44]

Ramipril or placebo

Lower decline in GFR (0.53 ml/min versus 0.88 ml/min); RR in doubling of baseline creatinine or ESRD

T2DM patients [45]

Ramipril or placebo

24% risk reduction in overt nephropathy

T2DM patients [46]

Enalapril or nifedipine

Greater reduction in albuminuria; 23.8% patients (versus 15.4%) reverted to normoalbuminuria; 19.1% patients (versus 30.8%) developed macroalbuminuria

ARB

T2DM patients with nephropathy [13]

Losartan or placebo

16% RR in doubling of serum creatinine concentration; 28% RR in ESRD; significant reduction in proteinuria versus placebo

Hypertensive T2DM with nephropathy [11]

Irbesartan or amlodipine or placebo

RR of doubling serum creatinine and of ESRD

T2DM patients with nephropathy [15]

Irbesartan or placebo

Reduction in the onset of diabetic nephropathy compared with placebo

T2DM patients [47]

Telmisartan or placebo

RR in progression to overt nephropathy; reduced UACR; increased microalbuminuria remission

T2DM patients with hypertension [48]

Telmisartan or ramipril

Both telmisartan and ramipril increase NO activity of renal endothelium which may preserve renal function

CVD and T2DM patients [49]

Telmisartan or placebo

Prevented increase in albuminuria (32% increase versus 63% increase); however, telmisartan was associated with a greater doubling of serum creatinine and decrease in estimated GFR, although there was no difference in terms of renal outcome

T2DM patients [50]

Valsartan or amlodipine

Greater reduction in urine albumin excretion (44% versus 8%)