Aims/hypothesis This meta-analysis aimed to compare the renal outcomes between ACE inhibitor (ACEI)/angiotensin Ⅱ receptor blocker (ARB) and other antihypertensive drugs or placebo in type 2 diabetes.Methods Publications were identified from Medline and Embase up to July 2011.Only randomised controlled trials comparing ACEI/ARB monotherapy with other active drugs or placebo were eligible.The outcome of end-stage renal disease, doubling of serum creatinine, microvascular complications, microalbuminuria, macroalbuminuria and albuminuria regression were extracted.Risk ratios were pooled using a random-effects model if heterogeneity was present;a fixed effects model was used in the absence of heterogeneity.Results Of 673 studies identified, 28 were eligible (n=13-4,912).In direct meta-analysis, ACEI/ARB had significantly lower risk of serum creatinine doubling (pooled RR=0.66 [95% CI 0.52, 0.83]), macroalbuminuria (pooled RR=0.70 [95% CI 0.50, 1.00]) and albuminuria regression (pooled RR=1.16 [95% CI 1.00, 1.39]) than other antihypertensive drugs, mainly calcium channel blockers (CCBs).Although the risks of end-stage renal disease and microalbuminuria were lower in the ACEI/ARB group (pooled RR 0.82 [95% CI 0.64, 1.05] and 0.84 [95% CI 0.61, 1.15], respectively), the differences were not statistically significant.The ACEI/ARB benefit over placebo was significant for all outcomes except microalbuminuria.A network meta-analysis detected significant treatment effects across all outcomes for both active drugs and placebo comparisons.Conclusions/interpretation Our review suggests a consistent reno-protective effect of ACEI/ARB over other antihypertensive drugs, mainly CCBs, and placebo in type 2 diabetes.The lack of any differences in BP decrease between ACEI/ARB and active comparators suggest this benefit is not due simply to the antihypertensive effect.