Do you have a preference between an ACEI and ARB when initiating therapy for a patient with diabetic kidney disease, albuminuria, and hypertension?

Why would you use an ACEi over an ARB these days? Cough is a LOT more common than stated. I see patients all the time who have a ticket, an annoyance that goes away on an ARB. Also, I don't see a $ argument, nor am I aware that ACEi have even been shown to be superior to ARB for reno protection.

Als...

Assuming we are talking about type 2 diabetic patients, I prefer ARBs, as they generally have a safer side effect profile. They are also more potent as anti-hypertensive agents.

In short, no. There are outcome data supporting both ACE inhibitors and ARBs (though not together) in slowing the progression of CKD in DM nephropathy. I typically consider allergy profiles, comorbidities like respiratory disorders, and availability of combination therapies when choosing to start an...

If you are going to use losartan as a hypertensive, it needs to be given twice a day as the duration of action is 12 hours.

I would also use an ARB first. ACEI can cause a slightly higher incidence of hyperkalemia due to their allowing the accumulation of bradykinin, which suppresses aldosterone secretion more than ARBs.

ARB only blocks the AT1 receptor site, while ACEI prevents angiotensin II formation by all pathways....

I agree that ACE inhibitors are associated with more side effects compared to ARBs; however, Cheng et al., PMID 24687000 demonstrated superior cardiovascular benefits and reduced all-cause mortality in diabetic patients treated with ACE inhibitors (not a head-to-head trial; this is just a meta-analy...

ACEIs are more titratable in dosing but can switch to ARB if side effects are noted.