ACE inhibitors versus AT(1) receptor antagonists in patients with chronic renal disease.

The success of Angiotensin-converting enzyme (ACE) inhibitors in preventing the progression of chronic renal insufficiency has led investigators to study the effects of other inhibitors of the renin-angiotensin system (RAS). Recently, the results of the first large-scale trials with angiotensin II type 1 receptor (AT1) antagonists became available (1,2). This article discusses the relative merits of ACE inhibitors, AT1 antagonists, and the combination of both drug classes in the treatment of chronic renal disease. First, we will review the potential differences between the effects of both drug classes on the basis of pathophysiologic considerations. Then we will provide a brief overview of clinical trials on the progression of renal diseases. Finally, we will review the clinical studies that have compared head-to-head ACE inhibitors and AT1 antagonists and discuss combination therapy with both drug classes. Except for the first part, we will limit our discussion to clinical studies in patients or volunteers.