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Discontinuation of Antihypertensive Drug Use Compared to Continuation in COVID-19 Patients: A Systematic Review with

Diego Chambergo-Michilot1,2, Fernando M Runzer-Colmenares3, Pedro A Segura-Saldaña4,5,6

  • 1Universidad Científica del Sur, Lima, Peru. diegochambergomichilot@hotmail.com.

High Blood Pressure & Cardiovascular Prevention : the Official Journal of the Italian Society of Hypertension
|May 12, 2023
PubMed

Insights

For patients with COVID-19, continuing angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEI/ARB) showed no significant difference in mortality or other outcomes compared to discontinuation. This systematic review analyzed multiple studies to assess the safety and efficacy of ACEI/ARB management during COVID-19 hospitalization.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Pharmacology

Background:

  • COVID-19 mortality is significant, particularly in patients with comorbidities like hypertension.
  • Management of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) in COVID-19 patients remains controversial.
  • This review addresses the impact of continuing versus discontinuing ACEI/ARB during COVID-19 infection.

Approach:

  • Systematic review and meta-analysis of observational studies and randomized controlled trials.
  • Searched PubMed, Scopus, and EMBASE for studies comparing ACEI/ARB continuation versus discontinuation in COVID-19 patients.
  • Assessed risk ratios, mean differences, and certainty of evidence using the GRADE approach.

Key Points:

  • Continuation of ACEI/ARB showed a reduced risk of death and ICU admission in cohort studies, but not in randomized controlled trials.
  • No significant differences were observed between continuation and discontinuation groups for hospitalization length, hypotension, or major adverse events.
  • Certainty of evidence ranged from moderate to high across outcomes.

Conclusions:

  • Current evidence suggests no significant difference in mortality or key clinical outcomes between continuing and discontinuing ACEI/ARB in hospitalized COVID-19 patients.
  • The findings support current guidelines recommending continuation of ACEI/ARB therapy in patients with COVID-19.
  • Further high-quality randomized controlled trials are needed to definitively establish the optimal management strategy.
Abstract

Keywords:
Angiotensin receptor antagonistsAngiotensin-converting enzyme inhibitorsCOVID-19HypertensionSystematic review (Source: MeSH NLM)

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