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Association Between Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Antivascular

Ryuichi Ohta1, Taichi Fujimori2, Kaoru Tanaka3

  • 1Community Care, Unnan City Hospital, Unnan, JPN.

Cureus
|April 17, 2026
PubMed

Insights

Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) may reduce proteinuria risk in cancer patients on anti-vascular endothelial growth factor (VEGF) therapy. This finding suggests a protective role for renin-angiotensin system inhibition.

Area of Science:

  • Oncology
  • Nephrology
  • Pharmacology

Background:

  • Anti-vascular endothelial growth factor (VEGF) therapy is a cornerstone in treating solid tumors.
  • Proteinuria is a common and dose-limiting side effect of anti-VEGF treatments.
  • The role of renin-angiotensin system inhibitors in managing anti-VEGF-induced proteinuria is not well-established.

Purpose of the Study:

  • To systematically review and meta-analyze the association between angiotensin-converting enzyme inhibitors (ACEi)/angiotensin II receptor blockers (ARBs) use and proteinuria risk in patients receiving anti-VEGF therapy.
  • To evaluate the potential renoprotective effects of ACEi/ARBs in this specific clinical context.

Main Methods:

  • Systematic review and meta-analysis of five retrospective observational studies.
  • Searched PubMed, Embase, and Web of Science for studies from January 2000 to September 2025.
  • Included studies comparing ACEi/ARB users with patients on other antihypertensive agents, excluding those without antihypertensive therapy.

Main Results:

  • ACEi/ARB use was significantly associated with a lower risk of any-grade proteinuria compared to other antihypertensive agents (pooled RR = 0.63; 95% CI = 0.42-0.95).
  • Moderate heterogeneity was observed across studies.
  • Sensitivity analyses confirmed the robustness of the findings.

Conclusions:

  • ACEi/ARB use appears to reduce the risk of proteinuria in patients undergoing anti-VEGF therapy.
  • These findings suggest a potential renoprotective role for renin-angiotensin system inhibition in this population.
  • Further prospective studies are needed to confirm causality and guide clinical practice.
Keywords:
angiotensin receptor antagonistsangiotensin-converting enzyme inhibitorsgeneral medicineneoplasmsproteinuriarenal insufficiencyvascular endothelial growth factor inhibitors

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