Evidence Summary

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ACE inhibitors for high blood pressure prevent kidney disease and death in people with diabetes and normal kidney function

Lv J, Perkovic V, Foote CV, et al. Antihypertensive agents for preventing diabetic kidney disease. Cochrane Database Syst Rev. 2012:12:CD-004136.

Review question

What are the effects of blood pressure–lowering drugs in preventing diabetic kidney disease?


End-stage kidney disease occurs when the kidneys no longer work at the level needed for daily life.

The most common causes of end-stage kidney disease are diabetes and high blood pressure.

People with diabetes who develop kidney disease are at increased risk of kidney failure, heart and circulatory problems, and death.

If blood pressure rises and stays high over time, it can damage the body in many ways.

How the review was done

This report is an update of a Cochrane Systematic Review first published in 2003 and updated in 2005.

This summary is based on a systematic review of 26 randomized controlled trials published since 2005. Studies included 61,264 adults. Follow-up ranged from 6 to 78 months (average of about 43 months).

Types of blood pressure–lowering medications studied were angiotensin-converting enzyme inhibitors (or ACE inhibitors), angiotensin-receptor blockers (ARBs), calcium channel blockers (CCBs), beta-blockers, and diuretics.

Medications were studied alone, in combination, or compared with placebo.

What the researchers found

Compared with placebo, ACE inhibitors

  • reduced the risk of diabetic kidney disease by 29%. Similar benefits occurred in people with and without high blood pressure and also when compared with calcium channel blockers.
  • reduced the risk of dying by 16%.
  • increased the risk of cough by 84%.

There were no differences in the risk of headache or elevated potassium in the blood (which is more likely to happen when the kidneys are not working properly).

Compared with placebo, angiotensin-receptor blockers

  • did not reduce the risk of diabetic kidney disease or dying from this condition.

There were no differences in the risk of cough, headache, or elevated blood potassium.


ACE inhibitors, a group of medications to lower high blood pressure, reduce the risk of kidney disease and death in people with diabetes and normal kidney function.

Comparison of blood pressure–lowering medications with placebo


ACE inhibitors

Angiotensin-receptor blockers

Diabetic kidney disease

29% decrease

No difference


16% decrease

No difference


84% increase

No difference


No difference

No difference

Elevated potassium in the blood

No difference

No difference



Angiotensin-converting enzyme inhibitors
A group of medications that control the hormone system that regulates blood pressure and water balance in the body.
Angiotensin-receptor blockers
A group of medications that block the chemicals that tighten the muscles around blood vessels. As a result, blood vessels enlarge and blood pressure is reduced.
Medications that slow down the heartbeat, decrease the force of the contractions of the heart muscles, and reduce blood vessel contraction in the heart, brain, as well as the rest of the body.
Calcium channel blockers
A group of medications that reduce the stiffness of large blood vessels and therefore lower (systolic) blood pressure.
Medications that increase the elimination of water from the body. Used to treat heart failure, high blood pressure, and some kidney diseases.
A harmless, inactive, and simulated treatment.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (

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