tetano
Editor, Senior Moderator
Eur Heart J Cardiovasc Pharmacother
. 2020 Dec 18;pvaa138.
doi: 10.1093/ehjcvp/pvaa138. Online ahead of print.
Renin-angiotensin system blockers, risk of SARS-CoV-2 infection and outcomes fromCoViD-19: systematic review and meta-analysis
Matthew M Y Lee[SUP] 1 [/SUP], Kieran F Docherty[SUP] 1 [/SUP], Naveed Sattar[SUP] 1 [/SUP], Neil Mehta[SUP] 2 [/SUP], Ankur Kalra[SUP] 3 4 [/SUP], Amy S Nowacki[SUP] 5 [/SUP], Scott D Solomon[SUP] 6 [/SUP], Muthiah Vaduganathan[SUP] 6 [/SUP], Mark C Petrie[SUP] 1 [/SUP], Pardeep S Jhund[SUP] 1 [/SUP], John J V McMurray[SUP] 1 [/SUP]
Affiliations
Abstract
Aims: This meta-analysis provides summary odds ratio (OR) estimates for associations between treatment with (vs. without) renin-angiotensin system (RAS) blockers and risk of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection and coronavirus disease 2019 (CoViD-19) severity (including case-fatality) in patients with hypertension, and in all patients (irrespective of hypertension).
Methods and results: PubMed, EMBASE, Web of Science, Google Scholar, medRxiv and SSRN were searched (May 02, 2020 to August 12, 2020) for non-randomised observational CoViD-19 studies. Event/patient numbers were extracted, comparing ACE inhibitor/ARB treatment (and each separately), to treatment with neither drug, for the outcomes: (a) Likelihood of SARS-CoV-2 infection; (b) CoViD-19 severity (including hospitalisation, Intensive Therapy Unit (ITU), ventilation); (c) Case-fatality. Risk of bias was assessed (ROBINS-I). Random-effects meta-analysis estimates were pooled. Eighty six studies including 459,755 patients (103,317 with hypertension), were analysed. In patients with hypertension, ACE inhibitor or ARB treatment was not associated with a greater likelihood of SARS-CoV-2 infection in 60,141 patients (OR 1.06, 95% CI 0.99-1.14), hospitalisation in 5,925 patients (OR 0.90, 0.62-1.31), ITU in 7,218 patients (OR 1.06, 0.73-1.56), ventilation (or ITU/ventilation/death) in 13,163 patients (OR 0.91, 0.72-1.15) or case-fatality in 18,735 patients with 2,893 deaths (OR 0.75, 0.61-0.92).
Conclusion: ACE inhibitors and ARBs appear safe in the context of SARS-CoV-2 infection and should not be discontinued. PROSPERO registration number: CRD42020186996.
Keywords: Angiotensin-converting enzyme inhibitor; COVID-19; angiotensin receptor blocker; meta-analysis; renin-angiotensin system; severe acute respiratory syndrome coronavirus 2.
. 2020 Dec 18;pvaa138.
doi: 10.1093/ehjcvp/pvaa138. Online ahead of print.
Renin-angiotensin system blockers, risk of SARS-CoV-2 infection and outcomes fromCoViD-19: systematic review and meta-analysis
Matthew M Y Lee[SUP] 1 [/SUP], Kieran F Docherty[SUP] 1 [/SUP], Naveed Sattar[SUP] 1 [/SUP], Neil Mehta[SUP] 2 [/SUP], Ankur Kalra[SUP] 3 4 [/SUP], Amy S Nowacki[SUP] 5 [/SUP], Scott D Solomon[SUP] 6 [/SUP], Muthiah Vaduganathan[SUP] 6 [/SUP], Mark C Petrie[SUP] 1 [/SUP], Pardeep S Jhund[SUP] 1 [/SUP], John J V McMurray[SUP] 1 [/SUP]
Affiliations
- PMID: 33337478
- DOI: 10.1093/ehjcvp/pvaa138
Abstract
Aims: This meta-analysis provides summary odds ratio (OR) estimates for associations between treatment with (vs. without) renin-angiotensin system (RAS) blockers and risk of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection and coronavirus disease 2019 (CoViD-19) severity (including case-fatality) in patients with hypertension, and in all patients (irrespective of hypertension).
Methods and results: PubMed, EMBASE, Web of Science, Google Scholar, medRxiv and SSRN were searched (May 02, 2020 to August 12, 2020) for non-randomised observational CoViD-19 studies. Event/patient numbers were extracted, comparing ACE inhibitor/ARB treatment (and each separately), to treatment with neither drug, for the outcomes: (a) Likelihood of SARS-CoV-2 infection; (b) CoViD-19 severity (including hospitalisation, Intensive Therapy Unit (ITU), ventilation); (c) Case-fatality. Risk of bias was assessed (ROBINS-I). Random-effects meta-analysis estimates were pooled. Eighty six studies including 459,755 patients (103,317 with hypertension), were analysed. In patients with hypertension, ACE inhibitor or ARB treatment was not associated with a greater likelihood of SARS-CoV-2 infection in 60,141 patients (OR 1.06, 95% CI 0.99-1.14), hospitalisation in 5,925 patients (OR 0.90, 0.62-1.31), ITU in 7,218 patients (OR 1.06, 0.73-1.56), ventilation (or ITU/ventilation/death) in 13,163 patients (OR 0.91, 0.72-1.15) or case-fatality in 18,735 patients with 2,893 deaths (OR 0.75, 0.61-0.92).
Conclusion: ACE inhibitors and ARBs appear safe in the context of SARS-CoV-2 infection and should not be discontinued. PROSPERO registration number: CRD42020186996.
Keywords: Angiotensin-converting enzyme inhibitor; COVID-19; angiotensin receptor blocker; meta-analysis; renin-angiotensin system; severe acute respiratory syndrome coronavirus 2.