Key result
Prior RAAS inhibitor use is linked to ~35% lower COVID-19 mortality in hypertensive patients.
Why the study?
The association between the use of RAAS inhibitors and the risk of mortality from COVID-19 in patients with hypertension was unclear.
Does prior use of RAAS inhibitors reduce mortality from COVID-19 in patients with hypertension?
Meta-Analysis (n=73,073)
Does prior use of RAAS inhibitors reduce mortality from COVID-19 in patients with hypertension?
Relative Risk: 0.65 (95% CI 0.45–0.94)
Prior use of RAAS inhibitors is associated with a lower risk of mortality in patients with hypertension hospitalized for COVID-19, suggesting a potential protective effect.
Hypothesis-generating for RAAS inhibitor benefit in hypertensive COVID-19 patients; does not support practice change without randomized confirmation.
OBJECTIVE: The association between the use of renin-angiotensin-aldosterone (RAAS) inhibitors and the risk of mortality from COVID-19 is unclear. We aimed to estimate the association of RAAS inhibitors, including ACE inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) with COVID-19 mortality risk in patients with hypertension. METHODS: PubMed (MEDLINE) SCOPUS, OVID, Cochrane Library databases and medrxiv.org were searched from 1 January 2020 to 1 September 2020. Studies reporting the association of RAAS inhibitors (ACEi or ARBs) and mortality in patients with hypertension, hospitalised for COVID-19 were extracted. Two reviewers independently extracted appropriate data of interest and assessed the risk of bias. All analyses were performed using random-effects models on log-transformed risk ratio (RR) estimates, and heterogeneity was quantified. RESULTS: =80%, p<0.01). Patients with hypertension with prior use of RAAS inhibitors were 35% less likely to die from COVID-19 compared with patients with hypertension not taking RAAS inhibitors (pooled RR 0.65, 95% CI 0.45 to 0.94). The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations was graded as 'moderate' quality. CONCLUSIONS: In this meta-analysis, with prior use of RAAS inhibitors was associated with lower risk mortality from COVID-19 in patients with hypertension. Our findings suggest a potential protective effect of RAAS-inhibitors in COVID-19 patients with hypertension. PROSPERO REGISTRATION NUMBER: The present study has been registered with PROSPERO (registration ID: CRD 42020187963).
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Ssentongo et al. (2020) conducted a meta-analysis in Hypertension hospitalized for COVID-19 (n=73,073). RAAS inhibitors (ACEi or ARBs) vs. Patients with hypertension not taking RAAS inhibitors was evaluated on Mortality from COVID-19 (RR 0.65, 95% CI 0.45 to 0.94). Prior use of RAAS inhibitors was associated with a 35% lower risk of mortality from COVID-19 in patients with hypertension compared to those not taking RAAS inhibitors (RR 0.65).
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