International Journal of Molecular Medical Science, 2025, Vol.15, No.5, 235-243 http://medscipublisher.com/index.php/ijmms 240 maintenance of stable glomerular filtration rate (eGFR) (Zhang et al., 2020). Many studies have shown that ACEI may be slightly better than ARB in protecting the kidneys and reducing the overall risk of death. However, both drugs have good effects in elderly patients with hypertension complicated with CKD (Zhang et al., 2020). Whether patients have diabetes or not, ACEI and ARB can significantly reduce proteinuria, but there is no significant difference in the effect on the decline of eGFR (Agustina et al., 2020; He et al., 2020). Compared with treating with only one drug, the combination of ACEI and ARB can significantly reduce the excretion of urinary protein and microalbumin. However, this combination of drugs may reduce the glomerular filtration rate (GFR) and increase the possibility of adverse reactions (Zhao et al., 2021; Xu and Fang, 2025). Overall, the protective effects of ACEI and ARB on the kidneys have been confirmed by many studies, and they are generally regarded as the preferred drugs for preventing the aggravation of chronic kidney disease in elderly patients with hypertension (Mhmndal et al., 2025). 5.3 Adverse reaction observation ACEI and ARB are usually tolerated by patients, but there are still some uncomfortable reactions that need to be closely monitored, especially in elderly patients. Common uncomfortable reactions of ACEI include coughing and angioedema, which may affect its use. In contrast, ARB has fewer side effects and is often used to replace ACEI, which patients are intolerant to (Chen et al., 2021). Both of these two drugs may cause hyperkalemia, especially when they are used together, or when the patient has reached the advanced stage of CKD, the risk of using them together will be higher (Zhang et al., 2020). Possible side effects include hypotension and acute kidney injury. If blood pressure drops too rapidly or the body is in a state of dehydration, the above problems are more likely to occur. Therefore, regular monitoring of blood potassium and renal function is of great significance for controlling related risks. Overall, as long as regular follow-up visits are made and the dosage of medication is adjusted according to the situation, ACEI and ARB remain safe and reliable treatment options for elderly patients with hypertension (Agustina et al., 2020; Zhao et al., 2021). 6 Clinical Value of ACEI/ARB Treatment in Elderly Population 6.1 Clear renal protective effect These protective effects are particularly important for elderly patients, as drug use is more vulnerable to kidney damage caused by hypertension and the risk of end-stage kidney disease is also greater. Most international treatment guidelines recommend ACEI or ARB as the first choice for elderly patients with hypertension, chronic kidney disease and proteinuria. These drugs can protect renal function and help patients recover in the long term (Alcocer et al., 2023). These protective effects are particularly important for elderly patients, as they are more vulnerable to kidney damage caused by hypertension and have a higher risk of developing end-stage renal disease. At present, most international treatment guidelines recommend ACEI or ARB as the first choice of drugs for elderly patients with hypertension, chronic kidney disease and proteinuria, which can protect renal function and improve long-term recovery (Mhmndal et al., 2025). 6.2 Good tolerance and safety ACEI and ARB generally have good tolerance in elderly patients. Since ACEI often causes cough and angioedema, ARB is often the preferred option (Zhang et al., 2020). Multiple large-scale studies and meta-analyses have shown that ARB has more advantages in terms of safety, with lower rates of drug withdrawal and adverse events, and is particularly suitable for the elderly population sensitive to drug side effects (Chen et al., 2021; Gallo et al., 2022). Although both ACEI and ARB may cause hyperkalemia, hypotension or acute kidney injury, these risks can usually be controlled through reasonable monitoring and dose adjustment. As long as regular follow-up and laboratory monitoring are conducted, these two types of drugs are generally safe and reliable and can be used for a long time in elderly patients with hypertension (Zhang et al., 2020; Mhmndal et al., 2025).
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