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Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors in COVID-19: Meta-analysis/Meta-regression
Terry Lee1, Alessandro Cau2, Matthew Pellan Cheng3
1Centre for Health Evaluation and Outcomes Science (CHEOS), University of British Columbia, Vancouver, British Columbia, Canada.
CJC Open
|April 12, 2021
Summary
Angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors are linked to reduced COVID-19 mortality. Adjusted analyses confirm this benefit, unlike unadjusted studies which may be confounded by patient comorbidities.
Area of Science:
- Cardiovascular Pharmacology
- Infectious Disease Epidemiology
- Clinical Trial Analysis
Background:
- Angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors may impact coronavirus disease 2019 (COVID-19) mortality.
- Previous meta-analyses might be confounded by higher comorbidity rates in ARB/ACE inhibitor users.
Purpose of the Study:
- To investigate the association between ARB/ACE inhibitor use and mortality in hospitalized COVID-19 patients.
- To address potential confounding factors, such as comorbidities, in existing research.
Main Methods:
- Systematic search of PubMed, MEDLINE, and Embase for relevant cohort studies and meta-analyses.
- Random effects meta-regression used to adjust for imbalances in age, sex, and key comorbidities (cardiovascular disease, hypertension, diabetes, chronic kidney disease).
Main Results:
- Analysis of 30 studies involving 17,281 patients revealed significant comorbidities among ARB/ACE inhibitor users.
- Adjusted meta-regression showed ARB/ACE inhibitor use was associated with significantly lower COVID-19 mortality (OR 0.77; 95% CI: 0.62, 0.96).
- Unadjusted meta-analysis did not find a significant association (OR 0.87; 95% CI: 0.71, 1.08).
Conclusions:
- ARB/ACE inhibitor use is associated with decreased mortality in COVID-19 patients after adjusting for key demographic and clinical factors.
- Unadjusted meta-analyses are potentially inappropriate for evaluating ARB/ACE inhibitors' effect on COVID-19 mortality due to indication bias.
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