ACE inhibitors and ARBs are widely used medications that play a critical role in protecting kidney and heart health, particularly for those living with chronic conditions like CKD (chronic kidney disease) and cardiovascular disease (CVD). These medications have been staples in medical treatment since the 1980s and remain essential tools in reducing complications from hypertension, glomerular diseases, and heart issues. Learn more about the benefits and risks of ACE inhibitors and ARBs when you have CKD.*

How These Medications Work

Though they function in slightly different ways, both drug classes help maintain lower blood pressure and reduce stress on the kidneys by interfering with the hormone angiotensin-2.

Angiotensin-2 (AT2) is a hormone that tightens blood vessels to increase blood pressure. In people with CKD or CVD, too much AT2 can damage delicate kidney filters and worsen heart conditions. ACE inhibitors and ARBs help by:

• ACE inhibitors. Reducing the body’s production of AT2
• ARBs. Blocking the receptors that AT2 uses to constrict blood vessels
  

Both result in more relaxed blood vessels, lower blood pressure, and less strain on the kidneys and heart. While they work differently, the outcome is essentially the same.

Choosing a Medication

These medications are taken orally, typically once daily, and are usually affordable as generics.

• ACE inhibitors (end in “-pril”): e.g., lisinopril, ramipril
• ARBs (end in “-sartan”): e.g., losartan, valsartan
  

Both classes offer equal effectiveness in slowing CKD progression, reducing albuminuria, and lowering cardiovascular risk. Doctors often start with an ACE inhibitor unless a patient experiences intrusive side effects. In such cases, they may switch to an ARB, which tends to be better tolerated.

Other considerations include patient history, tolerance to previous medications, and coexisting health conditions. While either class can be used safely by most people, healthcare providers may also choose based on availability, dosing convenience, or insurance coverage.

Risks, Side Effects, and Special Precautions

While generally safe, these medications can cause side effects like:

• Dry cough (mostly with ACE inhibitors)
• Low blood pressure
• High potassium levels
• Rarely, angioedema (serious swelling, often in part of the face)

According to experts, neither medication should be used during pregnancy, especially in the second and third trimesters, due to potential harm to the fetus. The risk of acute kidney injury (AKI) increases when combined with:

• NSAIDs, 
• Certain diuretics, or 
• Dehydration.  

Always consult your healthcare provider about blood test monitoring and medication combinations to minimize these risks, and ask when to test potassium and eGFR after starting one of these medications.

By understanding how these medicines work and what to watch for, you can make informed choices to protect your kidneys and heart.

*National Kidney Foundation. (2023, May 4). ACE Inhibitors and ARBs for CKD. https://www.kidney.org/kidney-topics/ace-inhibitors-and-arbs#:~

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