Much has been written about the choice between ACEIs and ARBs. In patients
with chronic heart failure or high risk acute MI, ARBs and ACEIs do not differ
in outcome for all cause mortality (1.
Both agents have similar effects on mortality and renal outcomes in diabetic nephropathy.(2)
However, ACEIs significantly reduce all cause mortality compared with placebo but ARBs do not.
The evidence base for ACEIs in heart failure is much more extensive than ARBs.
ARBs should be reserved for those cases where an ACEI is indicated but not tolerated