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Renin-angiotensin system blocker and outcomes of COVID-19: a systematic review and meta-analysis
Hyun Woo Lee1, Chang-Hwan Yoon2, Eun Jin Jang3
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Dongjak-gu, Seoul, The Republic of Korea.
Insights
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) did not increase mortality or severe disease risk in COVID-19 patients. ACEI/ARB therapy can continue safely for patients with COVID-19.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- The relationship between ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) and COVID-19 severity remains uncertain.
- Concerns exist regarding potential adverse effects of these common medications in COVID-19 patients.
Purpose of the Study:
- To systematically review and meta-analyze existing clinical studies.
- To investigate the association between ACEI/ARB use and the risk of mortality and severe disease in COVID-19 patients.
Main Methods:
- Systematic review and meta-analysis of clinical studies.
- Inclusion criteria: confirmed COVID-19 patients, categorized into ACEI/ARB and non-ACEI/ARB groups.
- Primary outcomes: all-cause mortality and severe disease.
Main Results:
- ACEI/ARB use was not associated with increased all-cause mortality (OR=0.52, 95% CI=0.37 to 0.72; moderate certainty).
- ACEI/ARB use did not correlate with an increased risk of severe COVID-19 (OR=0.68, 95% CI=0.44 to 1.07; low certainty).
- Analysis included data from over 12,000 patients across multiple studies.
Conclusions:
- ACEI/ARB therapy is not linked to higher mortality or severe manifestations in COVID-19 patients.
- Patients with COVID-19 can continue ACEI/ARB therapy without concern for drug-related worsening.
Background:
The association of ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) with disease severity of patients with COVID-19 is still unclear. We conducted a systematic review and meta-analysis to investigate if ACEI/ARB use is associated with the risk of mortality and severe disease in patients with COVID-19.
Methods:
We searched all available clinical studies that included patients with confirmed COVID-19 who could be classified into an ACEI/ARB group and a non-ACEI/ARB group up until 4 May 2020. A meta-analysis was performed, and primary outcomes were all-cause mortality and severe disease.
Results:
ACEI/ARB use did not increase the risk of all-cause mortality both in meta-analysis for 11 studies with 12 601 patients reporting ORs (OR=0.52 (95% CI=0.37 to 0.72), moderate certainty of evidence) and in 2 studies with 8577 patients presenting HRs. For 12 848 patients in 13 studies, ACEI/ARB use was not related to an increased risk of severe disease in COVID-19 (OR=0.68 (95% CI=0.44 to 1.07); I2=95%, low certainty of evidence).
Conclusions:
ACEI/ARB therapy was not associated with increased risk of all-cause mortality or severe manifestations in patients with COVID-19. ACEI/ARB therapy can be continued without concern of drug-related worsening in patients with COVID-19.
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