Enalapril versus losartan for adults with chronic kidney disease: a systematic review and meta-analysis

Nephrology (Carlton). 2013 Sep;18(9):605-14. doi: 10.1111/nep.12134.


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.

Keywords: adults; chronic kidney disease; enalapril; losartan.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Angiotensin II Type 1 Receptor Blockers / adverse effects
  • Angiotensin II Type 1 Receptor Blockers / therapeutic use*
  • Angiotensin-Converting Enzyme Inhibitors / adverse effects
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Biomarkers / blood
  • Blood Pressure / drug effects
  • Chi-Square Distribution
  • Cough / chemically induced
  • Creatinine / blood
  • Enalapril / adverse effects
  • Enalapril / therapeutic use*
  • Female
  • Humans
  • Kidney / drug effects*
  • Kidney / physiopathology
  • Losartan / adverse effects
  • Losartan / therapeutic use*
  • Male
  • Middle Aged
  • Odds Ratio
  • Renal Insufficiency, Chronic / blood
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / drug therapy*
  • Renal Insufficiency, Chronic / physiopathology
  • Renin-Angiotensin System / drug effects*
  • Risk Factors
  • Treatment Outcome
  • Uric Acid / blood


  • Angiotensin II Type 1 Receptor Blockers
  • Angiotensin-Converting Enzyme Inhibitors
  • Biomarkers
  • Uric Acid
  • Enalapril
  • Creatinine
  • Losartan