Role of angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers in the prevention of progression of renal disease.

Systemic hypertension is common in patients with acute as well as with chronic renal diseases. Hypertension is an important factor that contributes to the progression of renal failure. Cardiovascular disease is the leading cause of death and disability in patients with chronic renal failure and in those receiving renal replacement therapy. The prevalence of hypertensive nephropathy remains unabated. Hypertension and chronic renal failure are closely interlinked and govern the morbidity and mortality in patients afflicted by these conditions. There is considerable hope that effective control of hypertension may retard the progression of renal disease. Although mere control of hypertension is of paramount importance, specific pharmacologic approaches may offer certain important renal advantages. Angiotensin-converting enzyme (ACE) inhibitors, by the virtue of their intrarenal effects, exert favorable consequences on the kidney function (and structure, to some extent), particularly in patients with diabetic nephropathy and hypertension. Both experimental and clinical studies have demonstrated the renoprotective effects of ACE inhibitors; these drugs slow down the progression of renal disease independent of their antihypertensive actions. More recently, angiotensin-receptor blockers have been shown to exert similar glomerular effects as ACE inhibitors. Preliminary clinical data also suggest a possible role for angiotensin-receptor blockers in the prevention of progression of renal failure. Therapeutic agents that inhibit the renin-angiotensin axis hold considerable promise in the management of patients with renal disease by slowing down the rate of decline in renal function.