Effects of renin–angiotensin system blockers on renal and cardiovascular outcomes in patients with diabetic nephropathy: a meta-analysis of randomized controlled trials

  • X. Liu
  • L. Ma
  • Z. LiEmail author
Original Article



This study aimed to evaluate the effect f angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) on renal or cardiovascular outcomes in patients with diabetic nephropathy (DN).


PubMed, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) evaluating the treatment effects of ACEI and ARB on renal or cardiovascular outcomes in patients with DN until August 2017. The outcomes included end-stage renal disease (ESRD), doubling of serum creatinine levels, all-cause mortality, major cardiovascular events (MACEs), myocardial infarction (MI), stroke, and cardiac death. Relative risks (RR) with 95% confidence intervals (CIs) were used for calculating the summary results using a random-effects model.


Twenty-four RCTs including 57,818 patients with DN and 891 events of ESRD, 1050 doubling of serum creatinine concentration, 4352 all-cause mortality, 6342 MACEs, 1073 MI, 2900 stroke, and 1674 cardiac deaths were reported. Overall, the summary results suggested that in patients with DN, receiving ACEI did not have a significant effect on ESRD, doubling of serum creatinine levels, all-cause mortality, MI, stroke, and cardiac death, while ACEI significantly reduced the risk of total MACEs. Furthermore, ARB therapy was associated with a low risk of ESRD and doubling of serum creatinine levels, while it did not differ significantly on all-cause mortality, MACEs, MI, stroke, and cardiac death in patients with DN.


Patients with DN receiving ACEI had significantly reduced the risk of total MACEs, and ARB could reduce the incidence of ESRD and the doubling of serum creatinine levels.


Diabetic nephropathy ACEI ARB Meta-analysis 




Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interests.

Ethical approval

Not applicable.

Informed consent

Not applicable.

Supplementary material

40618_2020_1179_MOESM1_ESM.doc (152 kb)
Supplementary file1 (DOC 152 kb)
40618_2020_1179_MOESM2_ESM.doc (341 kb)
Supplementary file2 (DOC 341 kb)
40618_2020_1179_MOESM3_ESM.docx (42 kb)
Supplementary file3 (DOCX 42 kb)


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Copyright information

© Italian Society of Endocrinology (SIE) 2020

Authors and Affiliations

  1. 1.Department of NephrologyBeijing Luhe Hospital, Capital Medical UniversityBeijingChina
  2. 2.Department of NephrologyBeijing Chaoyang Hospital, Capital Medical UniversityBeijingChina

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