Key result
ACEI or ARB use is not linked to lower mortality in hypertensive COVID-19 patients.
Why the study?
The impact of ACEIs/ARBs use on the risks of severe COVID-19 and mortality in patients with hypertension was uncertain, as was the effect of discontinuing these drugs.
Meta-Analysis (n=63,893)
Yes
Odds Ratio: 0.87 (95% CI 0.75–1)
p-value: p=0.05
Supports continued ACEI/ARB use in hypertensive COVID-19 patients; reinforces neutrality on mortality and severity across meta-analyses.
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) share a target receptor with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The use of ACEIs/ARBs may cause angiotensin-converting enzyme 2 receptor upregulation, facilitating the entry of SARS-CoV-2 into host cells. There is concern that the use of ACEIs/ARBs could increase the risks of severe COVID-19 and mortality. The impact of discontinuing these drugs in patients with COVID-19 remains uncertain. We aimed to assess the association between the use of ACEIs/ARBs and the risks of mortality and severe disease in patients with COVID-19. A systematic search was performed in PubMed, EMBASE, Cochrane Library, and MedRxiv.org from December 1, 2019, to June 20, 2020. We also identified additional citations by manually searching the reference lists of eligible articles. Forty-two observational studies including 63,893 participants were included. We found that the use of ACEIs/ARBs was not significantly associated with a reduction in the relative risk of all-cause mortality [odds ratio (OR) = 0.87, 95% confidence interval (95% CI) = 0.75–1.00;I2= 57%,p= 0.05]. We found no significant reduction in the risk of severe disease in the ACEI subgroup (OR = 0.95, 95% CI = 0.88–1.02,I2= 50%,p= 0.18), the ARB subgroup (OR = 1.03, 95% CI = 0.94–1.13,I2= 62%,p= 0.48), or the ACEI/ARB subgroup (OR = 0.83, 95% CI = 0.65–1.08,I2= 67%,p= 0.16). Moreover, seven studies showed no significant difference in the duration of hospitalization between the two groups (mean difference = 0.33, 95% CI = −1.75 to 2.40,p= 0.76). In conclusion, the use of ACEIs/ARBs appears to not have a significant effect on mortality, disease severity, or duration of hospitalization in COVID-19 patients. On the basis of the findings of this meta-analysis, there is no support for the cessation of treatment with ACEIs or ARBs in patients with COVID-19.
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Dai et al. (2021) conducted a meta-analysis in COVID-19 with hypertension (n=63,893). Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) vs. Non-ACEI/ARB anti-hypertension drugs or no ACEI/ARB exposure was evaluated on All-cause mortality (OR 0.87, 95% CI 0.75-1.00, p=0.05). The use of ACEIs or ARBs was not significantly associated with an altered risk of all-cause mortality (OR 0.87) or severe disease in patients with COVID-19 and hypertension.
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