Key result
ACEI/ARB use is linked to ~30% lower mortality in hypertensive COVID-19 patients.
Why the study?
Conflicting results existed regarding the effect of ACE inhibitors and ARBs on mortality in patients with hypertension and concurrent COVID-19 infection, necessitating a pooled analysis.
Meta-Analysis (n=16,101)
Relative Risk: 0.7 (95% CI 0.53–0.91)
Absolute Event Rate: 12.15% vs 14.56%
p-value: p=< 0.007
Supports investigation of ACEI/ARB in hypertensive COVID-19; does not warrant practice change without randomized confirmation.
To determine the effect renin-angiotensin system blockers on the outcome in patients with hypertension and concurrent COVID-19 infection, we searched PubMed, the Cochrane Library, and Google Scholar for relevant articles. Twelve studies with a total of 16,101 patients met the inclusion criteria. The mortality rate among the users of angiotensin converting enzyme inhibitors or angiotensin receptor blockers was 12.15% and in non-users it was 14.56% (risk ratio 0.70, 95% CI [0.53-0.91], P < 0.007). There was no difference in the risk of death between the use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers (risk ratio 1.09, 95% CI [0.90 -1.32]). We conclude that the use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers improves mortality in patients with hypertension and concurrent COVID-19 infection, without a significant difference between ACEIs and ARBs in this population.
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Salah et al. (2020) conducted a meta-analysis in Hypertension and concurrent COVID-19 infection (n=16,101). Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) vs. Non-users of ACEIs or ARBs was evaluated on Mortality (risk ratio 0.70, 95% CI 0.53-0.91, p=< 0.007). The use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a 30% reduction in mortality (RR 0.70) compared to non-users in patients with hypertension and COVID-19.
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