No Difference in Renal Function Decline With ACE inhibitors or ARBs for Diabetes

A study comparing the effectivenesses of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) for protecting patients with type 2 diabetes from renal function decline found no significant difference between the two treatments. 

Patients with type 2 diabetes and renal complications are at an increased risk for cardiovascular events and further renal decline if the condition goes untreated. ACE inhibitors and ARBs are both recommended as first-line treatments for diabetic patients with hypertension, but they have also been shown to have renoprotective functions in this same patient population.

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Researchers led by Yunyu Huang, a PhD candidate at University Medical Center Groningen (The Netherlands), conducted a study published in the Journal of Comparative Effectiveness Research to compare the effectiveness of these two medications for protecting patients with type 2 diabetes from renal function decline in a real-world setting. 

Researchers retrospectively identified 3633 patients with type 2 diabetes who initiated treatment with either ACE inhibitors or ARBs between 2007 and 2012. They used estimated glomerular filtration rate and albuminuria-to-creatinine ratio to assess renal function change associated with each treatment. 

The average follow-up time for patients in both groups was 2.9 years. Renal stage measurements were recorded about 1.6 times per year for each group.

The average drug exposure over that period was significantly higher among the ARB group than among ACE inhibitor users. This was not found to be because of adherence, however, as the medication possession ratio was similar for both groups (ACE inhibitors, 85%; ARBs, 83.9%).  

The total number of incidences of deterioration of renal function stage was 217. Overall, differences in renal outcomes associated with each treatment were not found to be significant. For patients taking ACE inhibitors and ARBs, respectively, the rates of competing risk events  were similar (2% and 1.8%, respectively).

A competing risk regression model developed by the researchers showed that time to renal function decline for ARB users was slightly longer than for ACE inhibitor users (hazard ratio, 0.80; 95% CI, 0.58-1.10; P = .166); however, the effect was not statistically significant. 

The authors concluded that the two classes of medications are similarly effective for preventing renal function decline in patients with type 2 diabetes.

“These results are in line with the majority of head-to-head comparisons between ACE inhibitors and ARB in diabetic patients, and also in hypertensive patients with some exceptions that favored one over another,” the study authors wrote. “The strength of our study is the use of observational data of an unselected population of patients with [type 2 diabetes] as registered during the regular care process.” 

The researchers noted that the number of events in the matched population was relatively small, which may have been a study limitation. Other limitations associated with the use of data obtained during regular care were also noted, though the researchers felt that this was unlikely to have influenced the results.—Sean McGuire 


Huang Y, Haaijer-Ruskamp FM, Voorham J. Comparing the effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on renal function decline in diabetes. J Comp Eff Res. 2016;5(3):229-237.