Related Experiment Video
Updated: Feb 2, 2026
Author Spotlight: Evaluating the Adjuvant Efficacy and Safety of Angong Niuhuang Pill in Viral Encephalitis Treatment
Published on: April 19, 2024
The Long-Term Impact of Renin-Angiotensin System (RAS) Inhibition on Cardiorenal Outcomes (LIRICO): A Randomized,
Valeria Saglimbene1,2, Suetonia C Palmer3, Marinella Ruospo2
1Sydney School of Public Health, Faculty of Medicine and Health, Sydney, Australia.
Background:
The comparative effectiveness of treatment with angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or their combination in people with albuminuria and cardiovascular risk factors is unclear.
Methods:
In a multicenter, randomized, open label, blinded end point trial, we evaluated the effectiveness on cardiovascular events of ACE or ARB monotherapy or combination therapy, targeting BP<130/80 in patients with moderate or severe albuminuria and diabetes or other cardiovascular risk factors. End points included a primary composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and hospitalization for cardiovascular causes and a revised end point of all-cause mortality. Additional end points included ESRD, doubling of serum creatinine, albuminuria, eGFR, BP, and adverse events.
Results:
Because of slow enrollment, the trial was modified and stopped 41% short of targeted enrollment of 2100 participants, corresponding to 35% power to detect a 25% reduced risk in the primary outcome. Our analysis included 1243 adults, with median follow-up of 2.7 years. Efficacy outcomes were similar between groups (ACE inhibitor versus ARB, ACE inhibitor versus combination, ARB versus combination) as were rates of serious adverse events. The rate of permanent discontinuation for ARB monotherapy (6.3%) was significantly lower than for ACE inhibitor monotherapy (15.7%) or combined therapy (18.3%).
Conclusions:
Patients may tolerate ARB monotherapy better than ACE inhibitor monotherapy. However, data from this trial and similar trials, although as yet inconclusive, show no trend suggesting differences in mortality and renal outcomes with ACE inhibitors or ARBs as dual or monotherapy in patients with albuminuria and diabetes or other cardiovascular risk factors.
Insights
Angiotensin receptor blocker (ARB) monotherapy may be better tolerated than angiotensin-converting enzyme (ACE) inhibitor monotherapy. However, current data show no significant differences in cardiovascular or renal outcomes between ACE inhibitors and ARBs for patients with albuminuria.
Area of Science:
- Cardiology
- Nephrology
- Pharmacology
Background:
- The comparative effectiveness of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or their combination for patients with albuminuria and cardiovascular risk factors remains unclear.
- Albuminuria is a key indicator of cardiovascular and renal risk.
Purpose of the Study:
- To evaluate the effectiveness of ACE inhibitor monotherapy, ARB monotherapy, or their combination on cardiovascular events in patients with moderate to severe albuminuria and diabetes or other cardiovascular risk factors.
- To compare cardiovascular outcomes, mortality, renal function, and adverse events among the different treatment strategies.
Main Methods:
- A multicenter, randomized, open-label trial with blinded end points was conducted.
- 1243 adults with albuminuria and cardiovascular risk factors were included, with a median follow-up of 2.7 years.
- The primary composite end point included cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and cardiovascular hospitalization.
Main Results:
- Efficacy outcomes were similar across all treatment groups (ACE inhibitor vs. ARB, ACE inhibitor vs. combination, ARB vs. combination).
- Rates of serious adverse events were comparable between groups.
- Permanent discontinuation rates were significantly lower for ARB monotherapy (6.3%) compared to ACE inhibitor monotherapy (15.7%) and combination therapy (18.3%).
Conclusions:
- Angiotensin receptor blocker monotherapy may offer better patient tolerance compared to ACE inhibitor monotherapy.
- Current trial data, while inconclusive due to early termination, suggest no significant differences in mortality and renal outcomes between ACE inhibitors and ARBs, whether used as monotherapy or dual therapy, in patients with albuminuria and cardiovascular risk factors.
Related Concept Videos
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
02:38The Ras Gene
Ras is a...
01:24Small GTPases - Ras and Rho
Three regulatory proteins control their activity:
01:03Drug Control Governance: Regulatory Bodies and Their Impact
00:46Feedback Inhibition
01:11Clinical Trials: Overview