Angiotensin II receptor antagonists versus angiotensin converting enzyme inhibitors: effects on renal function

Recent work has suggested that proximal tubular reabsorption of sodium may be regulated by a local renin-angiotensin system which may be independent of the circulating renin-angiotensin system. The aim of this review was to examine the long-term renal consequences of blockade of the renin-angiotensin system by angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists.

Except in states of extreme volume depletion, in which ACE inhibitors may, unlike angiotensin II receptor antagonists, have an adverse effect on the glomerular filtration rate, no differences were observed between the two types of inhibitor. Like ACE inhibitors, the angiotensin II inhibitors TCV 116 and losartan cause a marked impairment in the renal adaptation to dietary sodium restriction, suggesting that blockade of the renin-angiotensin system is primarily involved in this process.

Further studies in human renovascular hypertension and chronic renal disease are required.