Renin–angiotensin system blockers, risk of SARS-CoV-2 infection and outcomes from CoViD-19: systematic review and meta-analysis

Lee, M. M.Y. et al. (2022) Renin–angiotensin system blockers, risk of SARS-CoV-2 infection and outcomes from CoViD-19: systematic review and meta-analysis. European Heart Journal: Cardiovascular Pharmacotherapy, 8(2), pp. 165-178. (doi: 10.1093/ehjcvp/pvaa138) (PMID:33337478) (PMCID:PMC7799280)

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Aims: This meta-analysis provides summary odds ratio (OR) estimates for associations between treatment with (vs. without) renin–angiotensin system blockers and risk of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection and coronavirus disease 2019 (CoViD-19) severity (including case-fatality) in patients with hypertension, and in all patients (irrespective of hypertension). Methods and results: PubMed, EMBASE, Web of Science, Google Scholar, medRxiv, and SSRN were searched (2 May 2020 to 12 August 2020) for non-randomized observational CoViD-19 studies. Event/patient numbers were extracted, comparing angiotensin-converting enzyme (ACE) inhibitor/angiotensin-receptor blocker (ARB) treatment (and each separately), to treatment with neither drug, for the outcomes: (i) likelihood of SARS-CoV-2 infection; (ii) CoViD-19 severity [including hospitalization, intensive therapy unit (ITU), ventilation]; (iii) case-fatality. The risk of bias was assessed (ROBINS-I). Random-effects meta-analysis estimates were pooled. Eighty-six studies including 459 755 patients (103 317 with hypertension), were analysed. In patients with hypertension, ACE inhibitor or ARB treatment was not associated with a greater likelihood of SARS-CoV-2 infection in 60 141 patients (OR 1.06, 95% CI 0.99–1.14), hospitalization in 5925 patients (OR 0.90, 0.62–1.31), ITU in 7218 patients (OR 1.06, 0.73–1.56), ventilation (or ITU/ventilation/death) in 13 163 patients (OR 0.91, 0.72–1.15) or case-fatality in 18 735 patients with 2893 deaths (OR 0.75, 0.61–0.92). Conclusion: Angiotensin-converting enzyme inhibitors and ARBs appear safe in the context of SARS-CoV-2 infection and should not be discontinued.

Item Type:Articles
Keywords:Angi, otensin-converting enzyme inhibitor, angiotensin receptor blocker, COVID-19, meta-analysis, renin–angiotensin system, severe acute respiratory syndrome coronavirus 2.
Glasgow Author(s) Enlighten ID:Lee, Matthew and Docherty, Dr Kieran and Jhund, Professor Pardeep and Sattar, Professor Naveed and McMurray, Professor John and Petrie, Professor Mark
Authors: Lee, M. M.Y., Docherty, K. F., Sattar, N., Mehta, N., Kalra, A., Nowacki, A. S., Solomon, S. D., Vaduganathan, M., Petrie, M. C., Jhund, P. S., and McMurray, J. J.V.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:European Heart Journal: Cardiovascular Pharmacotherapy
Publisher:Oxford University Press
ISSN (Online):2055-6845
Published Online:31 December 2020
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in European Heart Journal: Cardiovascular Pharmacotherapy 8(2): 165-178
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science