Protective effect of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor antagonists (ARBs) on microalbuminuria in diabetic patients

This review assesses the protective effect of ACEIs and ARBs on microalbuminuria in diabetic patients and identifying the preferred type based on their beneficial effects in addition to their blood pressure-reducing effect in diabetic patients with microalbuminuria and adverse drug reaction profile. In this review, articles published between 2001 and 2019 are included and MEDLINE search was used with key words such as diabetes, microalbuminuria, angiotensin II receptor antagonists, and ACEIs. ARBs reduced the risks of end stage renal disease (ESRD) and two-fold rise in the serum creatinine level; ACEIs did not reduce the risks of ESRD in an analysis of studies including both type 1 and type 2 diabetic patients. However, a meta-analytical review or study needs to be conducted to evaluate the comparative effects of ARBs and ACEIs in either type 1 or type 2 diabetic patients. Early treatment with ACEIs or ARBs decreased the risk of microalbuminuria in patients with type 2 diabetes. Telmisartan is found to be beneficial in microalbuminuria or diabetic nephropathy. Long-term therapy with higher dose of irbesartan resulted in consistent protective effects on the renal functions even after its withdrawal. ACEIs or ARBs are consideredas the 1st line therapy in both type 1 and 2 diabetic patients with microalbuminuria. ARBs are definitely preferred for patients who cannot tolerate ACE inhibitors. ARBs may be preferred over ACEIs due to their predominant renal protective effects in addition to their beneficial effect of improving blood pressure in type 2 diabetes mellitus. However, the comparative effects of ARBs and ACEIs in either type 1 or type 2 diabetic patients with microalbuminuria needs to be further evaluated in a randomized controlled study.