Enalapril showed similar effects to losartan on blood pressure and renal function in CKD patients, but carried a higher risk of dry cough (RR 2.88; 95% CI 1.11-7.48; P=0.03).
Meta-Analysis
Does enalapril improve blood pressure, renal function, and serum uric acid compared to losartan in adults with chronic kidney disease?
Enalapril and losartan have similar efficacy on surrogate renal and hemodynamic markers in CKD, but enalapril is associated with a significantly higher risk of dry cough.
Relative Risk: 2.88 (95% CI 1.11–7.48)
p-value: p=0.03
AIM: Both enalapril and losartan are effective and widely used in patients with chronic kidney disease (CKD). This review aimed to evaluate the benefits of enalapril and losartan in adults with CKD. METHODS: PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov were searched, without language limitations, for randomized controlled trials (RCT), in which enalapril and losartan were compared in adults with CKD. Standard methods, consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, were used. Reviewer Manager software, ver. 5.2, was used for meta-analysis. RESULTS: Of 318 citations retrieved, 17 RCT (14 parallel-group and three cross-over) met our inclusion criteria. The pooled analysis for parallel RCT showed that the effects of enalapril and losartan on blood pressure, renal function and serum uric acid (UA) were similar. Meta-analysis indicated that patients taking enalapril had a higher risk of dry cough (risk ratio, 2.88; 95% CI, 1.11-7.48; P=0.03). Sensitivity analysis showed good robustness of these findings. CONCLUSION: Enalapril has similar effects to losartan on systemic blood pressure, renal function and serum UA in patients with CKD, but carries a higher risk of dry cough. Larger trials are required to evaluate the effects of these medications on clinical outcomes.
He et al. (2013) conducted a meta-analysis in chronic kidney disease. Enalapril vs. Losartan was evaluated on Blood pressure, renal function, serum uric acid, and dry cough (RR 2.88, 95% CI 1.11-7.48, p=0.03). Enalapril showed similar effects to losartan on blood pressure and renal function in CKD patients, but carried a higher risk of dry cough (RR 2.88; 95% CI 1.11-7.48; P=0.03).