Impact of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on in-hospital mortality among patients with COVID-19: a systematic review and meta-analysis.
- Author:
Xinzhe James CAI
1
;
Julian Cheong Kiat TAY
1
;
Swee Leng KUI
1
;
Aung Soe TIN
2
;
Vern Hsen TAN
1
Author Information
- Publication Type:Systematic Review
- Keywords: angiotensin receptor blocker; angiotensin-converting enzyme inhibitor; coronavirus disease 2019; hypertension; mortality
- MeSH: Angiotensin Receptor Antagonists/therapeutic use*; Angiotensin-Converting Enzyme Inhibitors/therapeutic use*; COVID-19; Hospital Mortality; Humans; Hypertension/drug therapy*; SARS-CoV-2
- From:Singapore medical journal 2021;62(11):563-567
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:There are concerns that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may worsen the outcomes of patients with COVID-19. This systematic review and meta-analysis aimed to study the in-hospital mortality among COVID-19 patients who were on ACEIs/ARBs as compared to those not on ACEIs/ARBs.
METHODS:We searched PubMed, EMBASE, clinicaltrials.gov and Google Scholar between 1 January 2020 and 30 May 2020 to identify all studies that evaluated the use of ACEIs/ARBs and reported the in-hospital mortality outcomes of COVID-19 patients. Nine non-randomised studies were eligible for inclusion in the analysis. The primary outcome studied was the in-hospital mortality of COVID-19 patients who were on ACEIs/ARBs compared with those not on ACEIs/ARBs.
RESULTS:Of the 8,313 patients in the nine studies, 7,622 (91.7%) were from studies with all-comers, while 691 (8.3%) were from studies involving only patients with hypertension. 577 (14.6%) in-hospital deaths were observed out of a total of 3,949 patients with an outcome in the nine studies. Overall, no significant difference was observed in the in-hospital mortality between patients on ACEIs/ARBs and those not on ACEIs/ARBs (odds ratio [OR] 1.06, 95% confidence interval [CI] 0.75-1.50; p = 0.73). Further sensitivity analysis in the hypertension group and the all-comers group showed similar results (OR 0.88, 95% CI 0.58-1.32; p = 0.53 and OR 1.85, 95% CI 1.00-3.43; p = 0.05, respectively).
CONCLUSION:We observed that ACEIs/ARBs had no significant impact on the in-hospital mortality of COVID-19 patients and can be used safely in patients with indications.
