Key result
ACEI/ARB use is not linked to higher all-cause mortality in COVID-19 patients.
Why the study?
There is controversy over the effects of ACEIs and ARBs on prognosis in patients with COVID-19, necessitating further exploration of their impact on disease severity and mortality.
Does ACEI/ARB use reduce all-cause mortality in COVID-19 patients?
Meta-Analysis (n=1,321)
Does ACEI/ARB use reduce all-cause mortality in COVID-19 patients?
Relative Risk: 0.84 (95% CI 0.57–1.22)
p-value: p=0.10
ACEI/ARB use is not associated with increased mortality or disease severity in COVID-19 patients, supporting the recommendation that these medications should not be discontinued during COVID-19 infection.
Supports continued ACEI/ARB use in COVID-19; confirms no mortality increase and extends safety data.
BACKGROUND: There is controversy over the effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) on the prognosis in patients with coronavirus disease 2019 (COVID-19), therefore, we aim to further explore the effect of renin-angiotensin-aldosterone system inhibitors on COVID-19-associated disease severity and mortality. METHODS: We systematically searched PubMed, Embase, Cochrane Library databases, medRxiv, and bioRxiv from inception to 6 September 2021. The primary outcome was all-cause mortality. Secondary outcome was severe disease which was defined as admission to the intensive care unit, the use of noninvasive or invasive mechanical ventilation, or death. RESULTS: A total of 7 randomized controlled trials involving 1,321 COVID-19 patients were included. Fixed-effects meta-analysis demonstrated that the use of ACEI/ARB was not associated with higher risk of mortality (risk ratio [RR] = 0.84, 95% confidence interval [CI] 0.57-1.22, P = 0.10, I2 = 43%) and disease severity (RR = 0.86, 95% CI 0.71-1.05, P = 0.11, I2 = 47%). However, the subgroup analysis showed that compared with no ACEI/ARB use, the use of ARB was associated with a significant reduction of mortality (RR = 0.23, CI 0.09-0.60, P = 0.55, I2 = 0%) and disease severity (RR = 0.38, CI 0.19-0.77, P = 0.007). CONCLUSIONS: In conclusion, based on the available data, ACEI/ARB is not associated with the risk of mortality and disease severity in COVID-19 patients. And ACEI/ARB medications, especially ARB, should not be discontinued for patients with COVID-19.
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Yin et al. (2022) conducted a meta-analysis in COVID-19 (n=1,321). ACEI/ARB vs. no ACEI/ARB use was evaluated on all-cause mortality (RR 0.84, 95% CI 0.57-1.22, p=0.10). The use of ACEI/ARB was not associated with a higher risk of all-cause mortality in COVID-19 patients (RR 0.84; 95% CI 0.57-1.22; P=0.10).
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