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Meta-Analysis
. 2021 Apr 22;13(8):10853-10865.
doi: 10.18632/aging.202902. Epub 2021 Apr 22.

Does taking an angiotensin inhibitor increase the risk for COVID-19? - a systematic review and meta-analysis

Zheng Ma  1 , Mei-Ping Wang  2 , Lian Liu  3 , Shuang Yu  4 , Tian-Ran Wu  5 , Lei Zhao  1 , Ye-Ping Zhang  1 , Hai-Feng Liang  6 , Xin-Chun Yang  1
Affiliations
Meta-Analysis

Does taking an angiotensin inhibitor increase the risk for COVID-19? - a systematic review and meta-analysis

Zheng Ma et al. Aging (Albany NY). .

Abstract

Because SARS-COV2 entry into cells is dependent on angiotensin converting enzyme 2 (ACE2) and angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) increase ACE2 activity, the safety of ACEI/ARB usage during the coronavirus disease 2019 (COVID-19) pandemic is a controversial topic. To address that issue, we performed a meta-analysis following The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches of the Embase, MEDLINE, PubMed, and Cochrane Library databases identified 16 case-control studies examining the effect of ACEI/ARB on the incidence of COVID-19 and its severity. ACEI/ARB usage was associated with an increased risk of COVID-19 morbidity (odds ratio (OR) 1.20, 95% confidence interval (CI) 1.07-1.33, P=0.001) among the general population but not in a hypertensive population (OR 1.05, 95% CI 0.90-1.21, P=0.553). ACEI/ARB usage was not associated with an increased risk of COVID-19 morbidity (coefficient 1.00, 95% CI 1.00-1.00, P=0.660) when we adjusted for hypertension in the general population. ACEI/ARB usage was also not associated with an increased risk of severe illness (OR 0.90, 95%CI 0.55-1.47, P=0.664) or mortality (OR 1.43, 95%CI 0.97-2.10, P=0.070) in COVID-19 patients. Our meta-analysis revealed that ACEI/ARB usage was not associated with either the increased risk of SARS-COV2 infection or the adverse outcomes in COVID-19 patients.

Keywords: COVID-19; angiotensin converting enzyme inhibitors; angiotensin receptor blockers; angiotensin-converting enzyme 2; coronavirus disease 2019.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram of the process for identification of included studies.
Figure 2
Figure 2
Forest plot of the correlation between ACEIs/ARBs and COVID-19 in the general population (A) and a hypertensive population (B).
Figure 3
Figure 3
Forest plot of the correlation between ACEIs/ARBs and adverse outcomes in patients with COVID-19: (A) Severe COVID-19; (B) Mortality.
Figure 4
Figure 4
Forest plot of the correlation between ACEIs/ARBs and advanced life support in patients with COVID-19.
See this image and copyright information in PMC

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