Lee, M. M.Y. , Kondo, T., Campbell, R. T., Petrie, M. C. , Sattar, N. , Solomon, S. D., Vaduganathan, M., Jhund, P. S. and McMurray, J. J.V. (2024) Effects of Renin-Angiotensin system blockers on outcomes from COVID-19: a systematic review and meta-analysis of randomised controlled trials. European Heart Journal: Cardiovascular Pharmacotherapy, 10(1), pp. 68-80. (doi: 10.1093/ehjcvp/pvad067) (PMID:37740450) (PMCID:PMC10766905)
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Abstract
Background and aims: Randomized controlled trials (RCTs) have assessed the effects of renin–angiotensin system (RAS) blockers in adults with coronavirus disease 2019 (COVID-19). This meta-analysis provides estimates of the safety and efficacy of treatment with (vs. without) RAS blockers from these trials. Methods: PubMed, Web of Science, and ClinicalTrials.gov were searched (1 March–12 April 2023). Event/patient numbers were extracted, comparing angiotensin-converting enzyme (ACE) inhibitor/angiotensin-receptor blocker (ARB) treatment with no treatment, for the outcomes: intensive care unit (ICU) admission, mechanical ventilation, vasopressor use, acute kidney injury (AKI), renal replacement therapy (RRT), acute myocardial infarction, stroke/transient ischaemic attack, heart failure, thromboembolic events, and all-cause death. Fixed-effects meta-analysis estimates were pooled. Results: Sixteen RCTs including 3492 patients were analysed. Compared with discontinuation of RAS blockers, continuation was not associated with increased risk of ICU [risk ratio (RR) 0.96, 0.66–1.41], ventilation (RR 0.77, 0.55–1.09), vasopressors (RR 0.92, 0.58–1.44), AKI (RR 1.01, 0.40–2.56), RRT (RR 1.01, 0.46–2.21), or thromboembolic events (RR 1.07, 0.36–3.19). RAS blocker initiation was not associated with increased risk of ICU (RR 0.71, 0.47–1.08), ventilation (RR 1.12, 0.91–1.38), AKI (RR 1.28, 0.89–1.86), RRT (RR 1.66, 0.89–3.12), or thromboembolic events (RR 1.20, 0.06–23.70), although vasopressor use increased (RR 1.27, 1.02–1.57). The RR for all-cause death in the continuation/discontinuation trials was 1.24 (0.80–1.92), and 1.22 (0.96–1.55) in the initiation trials. In patients with severe/critical COVID-19, RAS blocker initiation increased the risk of all-cause death (RR 1.31, 1.01–1.72). Conclusion: ACE inhibitors and ARBs may be continued in non-severe COVID-19 infection, where indicated. Conversely, initiation of RAS blockers may be harmful in critically ill patients. PROSPERO registration number: CRD42023408926.
| Item Type: | Articles |
|---|---|
| Additional Information: | M.C.P., N.S., P.S.J., and J.J.V.M. are supported by a British Heart Foundation Centre of Research Excellence Grant (RE/18/6/34217). P.S.J. and J.J.V.M. are supported by the Vera Melrose Heart Failure Research Fund. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Kondo, Dr Toru and Lee, Matthew and Jhund, Professor Pardeep and Sattar, Professor Naveed and Campbell, Dr Ross and McMurray, Professor John and Petrie, Professor Mark |
| Creator Roles: | Lee, M.Formal analysis, Writing – original draft Kondo, T.Formal analysis, Writing – original draft Campbell, R.Writing – review and editing Petrie, M.Writing – review and editing Sattar, N.Writing – review and editing Jhund, P.Writing – review and editing McMurray, J.Supervision, Writing – original draft |
| Authors: | Lee, M. M.Y., Kondo, T., Campbell, R. T., Petrie, M. C., Sattar, N., Solomon, S. D., Vaduganathan, M., 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: | 2055-6837 |
| ISSN (Online): | 2055-6845 |
| Published Online: | 22 September 2023 |
| Copyright Holders: | Copyright © 2023 The Authors |
| First Published: | First published in European Heart Journal: Cardiovascular Pharmacotherapy 10(1): 68-80 |
| Publisher Policy: | Reproduced under a Creative Commons License |
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