Journal of Human Hypertension · Oct 31, 2026

Renin-angiotensin system inhibitors and arterial stiffness in chronic kidney disease: results from the chronic renal insufficiency cohort

By Shulman R, Cohen DL, Townsend R et al.

Chronic kidney disease (CKD) is associated with accelerated arterial stiffness, which contributes to its high burden cardiovascular disease. There is conflicting evidence on whether renin-angiotensin system inhibitors (RASIs) prevent arterial stiffness. We investigated the association between RASIs versus non-RASI antihypertensive medications and yearly changes in carotid-femoral pulse wave velocity (cfPWV) – a measure of arterial stiffness –using a linear mixed-effects model among participants in the Chronic Renal Insufficiency Cohort (CRIC) Study. As a secondary analysis, we restricted the cohort to participants on one antihypertensive medication at baseline. Lastly, we used a linear mixed-effects model to evaluate the relationship between RASI use and systolic blood pressure over time. Of the 1 201 participants who met inclusion criteria, 982 were on RASI and 219 were on a non-RASI medication. Individuals on RASI had a non-significant increase in cfPWV (adjusted cfPWV 0.19 m/s per year, 95% CI 0.14 to 0.25) compared to non-RASI users (adjusted cfPWV 0.15 m/s per year, 95% CI 0.00 to 0.30; p = 0.61). In the monotherapy cohort (N = 283), there was no difference in adjusted yearly change in cfPWV between RASI (0.11 m/s per year, 95% CI 0.02 to 0.21) and non-RASI users (0.03 m/s per year, 95% CI −0.14 to 0.20; p = 0.41). In both cohorts, there was no significant difference in systolic blood pressure over time between RASI and non-RASI users. Future research to mitigate the accelerated large artery stiffness in patients with CKD should focus on targetable mechanisms beyond the renin-angiotensin system.

doi.org/10.1038/s41371-026-01241-7Open accessPubMed 42966762Populations