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Expert Rev Cardiovasc Ther
. 2020 Sep 18.
doi: 10.1080/14779072.2020.1826308. Online ahead of print.
Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers and Outcomes in patients with COVID-19: A Systematic Review and Meta-Analysis
Kevin Bryan Lo 1 , Ruchika Bhargav 1 , Grace Salacup 1 , Jerald Pelayo 1 , Jeri Albano 1 , Peter A McCullough 2 3 , Janani Rangaswami 1 4
Affiliations
- PMID: 32945216
- DOI: 10.1080/14779072.2020.1826308
Abstract
Background: There remains controversy over the usage of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) in patients with coronavirus disease 2019 (COVID-19) given their interaction with the angiotensin converting enzyme-2 (ACE-2) receptor mechanism.
Objective: To investigate the impact of ACEI/ARB on COVID-19 associated disease severity and mortality through a systematic review and meta-analysis of existing literature.
Methods: We searched PubMed and CINAHL databases as well as pre-print servers for gray literature regarding studies investigating usage of ACEIs/ARBs in patients with confirmed COVID-19 compared to a control group of COVID-19 patients without ACEI/ARB use. COVID-19 related severity of disease, and death were identified as end points. Pooled odds ratios (OR) and their 95% confidence intervals (CI) were calculated using random-effects model.
Results: 21 studies were included in the meta-analysis. For mortality with ACEI/ARB use, the pooled odds ratio was 1.29 [0.89-1.87] p=0.18 with heterogeneity of 91%, while the pooled OR for COVID-19 severity was 0.94 [0.59-1.50] p=0.81 with heterogeneity of 89% (Figure2). In combining both mortality and severe disease outcomes, the pooled odds ratio was 1.09 [0.80-1.48] p=0.58 but with heterogeneity of 92%. [Figure: see text].
Conclusion: use of ACEI/ARB was not associated with increased mortality or severe COVID-19.
Keywords: ARBs; COVID-19; ace inhibitors; mortality; renin angiotensin aldosterone inhibitors; severe disease.