Background:Chronic kidney disease (CKD) remains a leading cause of morbidity and mortality worldwide. Blockade of the renin–angiotensin–aldosterone system (RAAS) using angiotensin-converting enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs) is standard of care to slow CKD progression. While both drug classes are widely used, questions remain regarding their comparative efficacy across stages and populations.
Aim:To evaluate and compare the efficacy of ACE inhibitors versus ARBs in slowing CKD progression using recent literature, hospital data, and clinician insights.
Methods:We synthesized evidence from 12 selected peer-reviewed studies (2011–2025) including randomized controlled trials, meta-analyses, and large cohort studies. Additionally, we incorporated secondary data from a tertiary hospital involving 128 patients with CKD stage 3–5, 65 receiving ACEis and 63 on ARBs. A brief clinician survey (n = 22) assessed physician preference and perceived efficacy. Primary endpoints were change in estimated glomerular filtration rate (eGFR), time to dialysis initiation, and proteinuria reduction. Secondary outcomes included tolerability and demographic effects.
Results:Literature review revealed that ACE inhibitors reduce the odds of dialysis initiation by 35% in stage 3 CKD (1), while ARBs showed similar effects in proteinuria reduction but less consistent renal protection (2, 4). In our hospital data, ACEi users had a slower eGFR decline (−3.2 vs −4.1 mL/min/1.73m²/year; p = 0.04). 64% of surveyed physicians preferred ACEis for initial therapy citing superior long-term renal protection (Survey Q2). However, cough-related intolerance led to ARB switching in 18% of ACEi users (local dataset).
ConclusionACE inhibitors demonstrate marginally superior efficacy in slowing CKD progression compared to ARBs, especially in early-stage disease. However, individual tolerability and comorbid conditions influence real-world outcomes. Further head-to-head studies are warranted to personalize RAAS blockade strategies in CKD.
Keywords:chronic kidney disease, ACE inhibitors, ARBs, eGFR, RAAS, nephropathy, proteinuria, comparative efficacy