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Meta-Analysis
. 2020 Sep 10;22(11):90.
doi: 10.1007/s11906-020-01101-w.

Renin-Angiotensin System Inhibitors and COVID-19: a Systematic Review and Meta-Analysis. Evidence for Significant Geographical Disparities

Dimitrios Patoulias  1 , Alexandra Katsimardou  1 , Konstantinos Stavropoulos  1 , Konstantinos Imprialos  1 , Maria-Styliani Kalogirou  1 , Michael Doumas  2
Affiliations
Meta-Analysis

Renin-Angiotensin System Inhibitors and COVID-19: a Systematic Review and Meta-Analysis. Evidence for Significant Geographical Disparities

Dimitrios Patoulias et al. Curr Hypertens Rep. .

Abstract

Purpose of review: While the COVID-19 pandemic is constantly evolving, it remains unclear whether the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) affects the clinical course of SARS-CoV-2 infection. For this meta-analysis, PubMed, CENTRAL, and grey literature were searched from their inception to 19 May 2020 for randomized, controlled trials or observational studies that evaluate the association between the use of either ACE inhibitors or ARBs and the risk for major clinical endpoints (infection, hospitalization, admission to ICU, death) in adult patients during the COVID-19 pandemic. In addition, a subgroup geographical analysis of outcomes was performed. Studies including less than 100 subjects were excluded from our analysis.

Recent findings: In total, 25 observational studies were included. ACE inhibitors and ARBs were not associated with increased odds for SARS-CoV-2 infection, admission to hospital, severe or critical illness, admission to ICU, and SARS-CoV-2-related death. In Asian countries, the use of ACE inhibitors/ARBs decreased the odds for severe or critical illness and death (OR = 0.37, 95% CI 0.16-0.89, I2 = 83%, and OR = 0.62, 95% CI 0.39-0.99, I2 = 0%, respectively), whereas they increased the odds for ICU admission in North America and death in Europe (OR = 1.75, 95% CI 1.37-2.23, I2 = 0%, and OR = 1.68, 95% CI 1.05-2.70, I2 = 82%, respectively). ACE inhibitors might be marginally protective regarding SARS-CoV-2-related death compared with ARBs (OR = 0.86, 95% CI 0.74-1.00, I2 = 0%). Randomized controlled trials are needed to confirm the aforementioned associations between ACE inhibitors, ARBs, and SARS-CoV-2.

Keywords: ACE inhibitors; ARBs; Angiotensin receptor blockers; Angiotensin-converting enzyme inhibitors; COVID-19; Hypertension; RAS inhibitors; Renin-angiotensin inhibitors; SARS-CoV-2.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow diagram depicting the study selection process
Fig. 2
Fig. 2
a Odds for SARS-CoV-2-positive testing, b odds for admission to hospital, c odds for severe or critical illness, d odds for admission to ICU, and e odds for SARS-CoV-2-related death, for ACE inhibitors/ARBs users compared with non-users
Fig. 2
Fig. 2
a Odds for SARS-CoV-2-positive testing, b odds for admission to hospital, c odds for severe or critical illness, d odds for admission to ICU, and e odds for SARS-CoV-2-related death, for ACE inhibitors/ARBs users compared with non-users
Fig. 2
Fig. 2
a Odds for SARS-CoV-2-positive testing, b odds for admission to hospital, c odds for severe or critical illness, d odds for admission to ICU, and e odds for SARS-CoV-2-related death, for ACE inhibitors/ARBs users compared with non-users
Fig. 3
Fig. 3
a Odds for SARS-CoV-2-positive testing, b odds for admission to ICU, and c odds for SARS-CoV-2-related death, for ACE inhibitors users compared with ARBs users
See this image and copyright information in PMC

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References

    1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, Zhao X, Huang B, Shi W, Lu R, Niu P, Zhan F, Ma X, Wang D, Xu W, Wu G, Gao GF, Tan W, China Novel Coronavirus Investigating and Research Team A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382:727–733. doi: 10.1056/NEJMoa2001017. - DOI - PMC - PubMed
    1. WHO Coronavirus Disease (COVID-19) Dashboard. World Health Organization, Assessed on May 27th, 2020. https://covid19.who.int/. Accessed 27 May 2020.
    1. Li W, Moore MJ, Vasilieva N, Sui J, Wong SK, Berne MA, Somasundaran M, Sullivan JL, Luzuriaga K, Greenough TC, Choe H, Farzan M. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature. 2003;426:450–454. doi: 10.1038/nature02145. - DOI - PMC - PubMed
    1. Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181:271–80.e8. doi: 10.1016/j.cell.2020.02.052. - DOI - PMC - PubMed
    1. Wrapp D, Wang N, Corbett KS, Goldsmith JA, Hsieh CL, Abiona O, Graham BS, McLellan JS. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science. 2020;367:1260–1263. doi: 10.1126/science.abb2507. - DOI - PMC - PubMed

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