Key result
Among hospitalized patients with COVID-19, ACEi/ARB use was not associated with an increased risk of mortality compared to control (RR 0.97; 95% CI 0.64-1.47; p=0.89).
Why the study?
Does ACEi/ARB use reduce mortality, ICU admission, or mechanical ventilation in hospitalized patients with COVID-19?
Meta-Analysis
Does ACEi/ARB use reduce mortality, ICU admission, or mechanical ventilation in hospitalized patients with COVID-19?
Relative Risk: 0.97 (95% CI 0.64–1.47)
p-value: p=0.89
The use of ACEi/ARBs in hospitalized COVID-19 patients is not associated with an increased risk of mortality, ICU admission, or mechanical ventilation, supporting their continuation when clinically indicated.
Supports continuing ACEi/ARBs in hospitalized COVID-19; confirms neutral effect on mortality and progression with updated RCT meta-analysis.
BACKGROUND: Our prior analysis demonstrated no significant difference in risk of mortality or disease progression among patients with COVID-19. With the availability of findings from randomized controlled trials (RCTs), we provide an updated review of RCTs which explored the outcomes among hospitalized patients with COVID-19 treated with Angiotensin Converting Enzyme inhibitor (ACEis)/Angiotensin Receptor Blockers (ARBs) versus control. RESEARCH DESIGN AND METHODS: This systematic review and meta-analysis covers RCTs exploring mortality, intensive care unit admission, and mechanical ventilation outcomes among hospitalized COVID-19 patients treated with ACEi/ARBs. RESULTS: Ten studies were included in this meta-analysis. For mortality with ACEi/ARB utilization among hospitalized COVID-19 patients, the pooled risk ratio (RR) was 0.97 (95% CI 0.64-1.47, p = 0.89) with heterogeneity of 26%. Further, the pooled RR for ACEi/ARB use on ICU admission and mechanical ventilation were 0.55 (0.55-1.08, p = 0.13) with a heterogeneity of 0% and 1.02 (0.78-1.32, p = 0.91) with a heterogeneity of 0%, respectively. CONCLUSION: Among hospitalized patients with COVID-19, the use of ACEi/ARB was not associated with increased risk of mortality, ICU admission, or mechanical ventilation compared to control. These findings support continuation of ACEi/ARB for whom baseline clinical indications for these agents exist.
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Paguio et al. (2023) conducted a meta-analysis in COVID-19. Angiotensin Converting Enzyme inhibitors (ACEis) / Angiotensin Receptor Blockers (ARBs) vs. Control was evaluated on Mortality (RR 0.97, 95% CI 0.64-1.47, p=0.89). Among hospitalized patients with COVID-19, ACEi/ARB use was not associated with an increased risk of mortality compared to control (RR 0.97; 95% CI 0.64-1.47; p=0.89).
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