ACE INHIBITORS, ANGIOTENSIN RECEPTOR BLOCKERS, AND ANGIOTENSIN RECEPTOR-NEPRILYSIN INHIBITORS IN CONTEMPORARY CARDIOVASCULAR AND RENAL CARE: A NARRATIVE REVIEW

Mateusz Meszka; Aleksandra Woźniak; Aleksandra Straszewska; Patrycja Sobantka; Szymon Mokrzycki; Matylda Król; Anna Mamach; Katarzyna Aleksandrowicz; Zofia Grodzka; Ewa Bełc; Karolina Brzezińska

doi:10.31435/ijitss.3(51).2026.6257

Authors

Mateusz Meszka Central Teaching Hospital of the Medical University of Lodz, Poland https://orcid.org/0009-0001-6147-7000
Aleksandra Woźniak Norbert Barlicki University Clinical Hospital No. 1 in Łódź, Poland https://orcid.org/0009-0003-5382-1451
Aleksandra Straszewska Central Teaching Hospital of the Medical University of Lodz, Poland https://orcid.org/0009-0003-6293-9689
Patrycja Sobantka Central Teaching Hospital of the Medical University of Lodz, Poland https://orcid.org/0009-0004-3128-5181
Szymon Mokrzycki Norbert Barlicki University Clinical Hospital No. 1 in Łódź, Poland https://orcid.org/0009-0005-8228-2711
Matylda Król Copernicus Memorial Hospital, Łódź, Poland https://orcid.org/0009-0000-7759-4933
Anna Mamach Norbert Barlicki University Clinical Hospital No. 1 in Łódź, Poland https://orcid.org/0009-0004-5934-8674
Katarzyna Aleksandrowicz Medical University of Lodz, Poland https://orcid.org/0009-0008-5935-8265
Zofia Grodzka Independent Public Health Care Complex named after Marshal Józef Piłsudski in Płońsk (SPZZOZ), Poland https://orcid.org/0009-0002-0904-810X
Ewa Bełc University Clinical Hospital No. 2 of the Medical University of Lodz, Poland https://orcid.org/0009-0004-0224-8162
Karolina Brzezińska Medical University of Lodz, Poland https://orcid.org/0009-0008-4403-6060

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.6257

Keywords:

ACE Inhibitors, Angiotensin Receptor Blockers, Sacubitril/Valsartan, Heart Failure, Chronic Kidney Disease, Guideline-Directed Therapy

Abstract

This narrative review critically compares angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and angiotensin receptor-neprilysin inhibitors (ARNIs) in contemporary cardiovascular and renal care, with particular emphasis on guideline-directed use, safety monitoring, adherence, and treatment implementation. A structured narrative search of PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library was completed on 28 June 2026. Randomized trials, systematic reviews, large observational studies, target-trial emulations, and international guideline documents were prioritized. ACEIs and ARBs provide broadly comparable blood pressure reduction and nephroprotection in many populations, whereas ARBs are usually better tolerated, mainly because cough and bradykinin-mediated angioedema are less frequent. ACEIs remain particularly well established after myocardial infarction. ARNIs have the most clearly confirmed advantage in eligible symptomatic patients with HFrEF, but their benefit should not be automatically extrapolated to uncomplicated hypertension, CKD without heart failure, or post-myocardial infarction patients without a heart failure phenotype. Optimal selection requires integration of evidence, laboratory monitoring, availability, costs, and patient preferences.

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