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Meta-Analysis
. 2021 Jul;28(4):405-416.
doi: 10.1007/s40292-021-00462-w. Epub 2021 Jun 28.

Safety and Efficacy of Renin-Angiotensin-Aldosterone System Inhibitors in COVID-19 Population

Yasar Sattar #  1 , Pradeeksha Mukuntharaj #  2 , Mohamed Zghouzi  3 , Abdul-Rahman M Suleiman  3 , Hassan Attique  4 , Waqas Ullah  5 , Muhammad Khawar Sana  6 , Nathan Zaher  3 , Maham Mehmood  7 , Rajkumar P Doshi  8 , Ankur Panchal  9 , Tanveer Mir  3 , Muhammad Nadeem  10 , Omar E Ali  3 , Mohamad Mohamed  11 , Rodrigo Bagur  12 , Islam Y Elgendy  13 , Mamas A Mamas  11 , M Chadi Alraies  14
Affiliations
Meta-Analysis

Safety and Efficacy of Renin-Angiotensin-Aldosterone System Inhibitors in COVID-19 Population

Yasar Sattar et al. High Blood Press Cardiovasc Prev. 2021 Jul.

Abstract

Introduction: The safety of renin-angiotensin-aldosterone system inhibitors (RAASi) among COVID-19 patients has been controversial since the onset of the pandemic.

Methods: Digital databases were queried to study the safety of RAASi in COVID-19. The primary outcome of interest was mortality. The secondary outcome was seropositivity improvement/viral clearance, clinical manifestation progression, and progression to intensive care units. A random-effect model was used to compute an unadjusted odds ratio (OR).

Results: A total of 49 observational studies were included in the analysis consisting of 83,269 COVID-19 patients (RAASi n = 34,691; non-RAASi n = 48,578). The mean age of the sample was 64, and 56% were males. We found that RAASi was associated with similar mortality outcomes as compared to non-RAASi groups (OR 1.07; 95% CI 0.99-1.15; p > 0.05). RAASi was associated with seropositivity improvement including negative RT-PCR or antibodies, (OR 0.96; 95% CI 0.93-0.99; p < 0.05). There was no association between RAASi versus control with progression to ICU admission (OR 0.99; 95% CI 0.79-1.23; p > 0.05) or higher odds of worsening of clinical manifestations (OR 1.04; 95% CI 0.97-1.11; p > 0.05). Metaregression analysis did not change our outcomes for effect modifiers including age, sex, comorbidities, RAASi type, or study type on outcomes.

Conclusions: COVID-19 is not a contraindication to hold or discontinue RAASi as they are not associated with higher mortality or worsening symptoms. Continuation of RAASi might be associated with favorable outcomes in COVID-19, including seropositivity/viral clearance.

Keywords: ACEi; ARB; Angiotensin receptor blocker; Angiotensin-converting enzyme inhibitor; COVID-19; RAASi; Renin–angiotensin–aldosterone system inhibitors.

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Conflict of interest statement

Not applicable.

Figures

Fig. 1
Fig. 1
PRISMA strategy for systematic review and meta-analysis
Fig. 2
Fig. 2
Forest plots showing pooled mortality outcomes (left) and seropositivity rates (right) among COVID-19 with RAASi
Fig. 3
Fig. 3
Forest plot showing pooled severity outcomes (left) and ICU admission rates (right) among COVID -19 patients on RAASi and No RAASi
See this image and copyright information in PMC

References

    1. COVID-19 Map—Johns Hopkins Coronavirus Resource Center [Internet]. Johns Hopkins Coronavirus Resource Center.: https://coronavirus.jhu.edu/map.html.
    1. Sattar Y, Ullah W, Rauf H, Virk HUH, Yadav S, Chowdhury M, Connerney M, Mamtani S, Pahuja M, Patel RD, Mir T, Almas T, Moussa Pacha H, Chadi Alraies M. COVID-19 cardiovascular epidemiology, cellular pathogenesis, clinical manifestations and management. Int J Cardiol Heart Vasc. 2020;29:100589. 10.1016/j.ijcha.2020.100589. PMID: 32724831; PMCID: PMC7359794. - PMC - PubMed
    1. Oudit G, Kassiri Z, Jiang C, Liu P, Poutanen S, Penninger J, Butany J. SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. Eur J Clin Invest. 2009;39:618–625. doi: 10.1111/j.1365-2362.2009.02153.x. - DOI - PMC - PubMed
    1. Negreira-Caamaño M, Piqueras-Flores J, Martínez-DelRio J, Nieto-Sandoval-Martin-DeLaSierra P, Aguila-Gordo D, Mateo-Gomez C, Salas-Bravo D, Rodriguez-Martinez M, Negreira-Caamaño M. Impact of treatment with renin-angiotensin system inhibitors on clinical outcomes in hypertensive patients hospitalized with COVID-19. High Blood Press Cardiovasc Prev. 2020;27(6):561–568. - PMC - PubMed
    1. Vaduganathan M, Vardeny O, Michel T, McMurray JJV, Pfeffer MA, Solomon SD. Renin-angiotensin-aldosterone system inhibitors in patients with Covid-19. N Engl J Med. 2020;382(17):1653–1659. doi: 10.1056/NEJMsr2005760. - DOI - PMC - PubMed

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