Effect of Renin-Angiotensin-Aldosterone System Inhibitors in Patients with COVID-19: a Systematic Review and Meta-analysis of 28,872 Patients

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Abstract

Purpose of Review

The role of renin-angiotensin-aldosterone system (RAAS) inhibitors, notably angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs), in the COVID-19 pandemic has not been fully evaluated. With an increasing number of COVID-19 cases worldwide, it is imperative to better understand the impact of RAAS inhibitors in hypertensive COVID patients. PubMed, Embase and the pre-print database Medrxiv were searched, and studies with data on patients on ACEi/ARB with COVID-19 were included. Random effects models were used to estimate the pooled mean difference with 95% confidence interval using Open Meta[Analyst] software.

Recent Findings

A total of 28,872 patients were included in this meta-analysis. The use of any RAAS inhibition for any conditions showed a trend to lower risk of death/critical events (OR 0.671, CI 0.435 to 1.034, p = 0.071). Within the hypertensive cohort, however, there was a significant lower association with deaths (OR 0.664, CI 0.458 to 0.964, p = 0.031) or the combination of death/critical outcomes (OR 0.670, CI 0.495 to 0.908, p = 0.010). There was no significant association of critical/death outcomes within ACEi vs non-ACEi (OR 1.008, CI 0.822 to 1.235, p = 0.941) and ARB vs non-ARB (OR 0.946, CI 0.735 to 1.218, p = 0.668).

Summary

This is the largest meta-analysis including critical events and mortality data on patients prescribed ACEi/ARB and found evidence of beneficial effects of chronic ACEi/ARB use especially in hypertensive cohort with COVID-19. As such, we would strongly encourage patients to continue with RAAS inhibitor pharmacotherapy during the COVID-19 pandemic.

Electronic supplementary material

The online version of this article (10.1007/s11883-020-00880-6) contains supplementary material, which is available to authorized users.

Related collections

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Author and article information

Contributors

Vassilios S Vassiliou:

ORCID: https://orcid.org/0000-0002-4005-7752

v.vassiliou@uea.ac.uk

Journal

Journal ID (nlm-ta): Curr Atheroscler Rep

Journal ID (iso-abbrev): Curr Atheroscler Rep

Title: Current Atherosclerosis Reports

Publisher: Springer US (New York )

ISSN (Print): 1523-3804

ISSN (Electronic): 1534-6242

Publication date (Electronic): 24 August 2020

Publication date PMC-release: 24 August 2020

Publication date (Print): 2020

Volume: 22

Issue: 10

Electronic Location Identifier: 61

Affiliations

[1 ]GRID grid.416391.8, Norfolk and Norwich University Hospital, ; Norwich, UK

[2 ]GRID grid.8273.e, ISNI 0000 0001 1092 7967, Norwich Medical School, , University of East Anglia, ; Norwich Research Park, Norwich, NR4 7UQ UK

Author information

Vassilios S Vassiliou https://orcid.org/0000-0002-4005-7752

Article

Publisher ID: 880

DOI: 10.1007/s11883-020-00880-6

PMC ID: 7443394

PubMed ID: 32830286

SO-VID: e5078aa0-4e88-49dc-819c-96d2ee3f26c0

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Funding

Funded by: University of East Anglia

Custom metadata

ScienceOpen disciplines: Immunology

Keywords: renin-angiotensin-aldosterone system,hypertension,coronavirus,covid

Data availability:

ScienceOpen disciplines: Immunology

Keywords: renin-angiotensin-aldosterone system, hypertension, coronavirus, covid