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The divergent protective effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on clinical outcomes of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis.
Xie, Qiuping; Tang, Shuai; Li, Yining.
  • Xie Q; Zhuzhou Central Hospital, Department of Cardiology, Zhuzhou, China.
  • Tang S; Xuzhou Medical University, Department of Pharmacy, Xuzhou, China.
  • Li Y; Second Xiangya Hospital, Department of Radiology, Changsha, China.
Ann Palliat Med ; 11(4): 1253-1263, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1518874
ABSTRACT

BACKGROUND:

Some studies have speculated that patients on angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) are more susceptible to adverse outcomes of coronavirus disease 2019 (COVID-19). Here, we performed a systematic review and meta-analysis to evaluate the safety and efficacy of administering ACEIs and ARBs to patients with COVID-19.

METHODS:

Studies of COVID-19 were collected from the PubMed, Embase, medRxiv and BioRxiv databases. The pooled relative risk odds ratio (OR) and 95% confidence interval (95% CI) were calculated. Subgroup analyses were conducted by medication (ACEIs and ARBs) and geographical location (China and outside China). Inter-study heterogeneity was assessed using meta-regression. Begg's test, Egger's test and funnel plots were adopted to evaluate possible publication bias.

RESULTS:

Thirty studies containing 10,434 adult patients were included in our meta-analysis. The pooled result indicated that the administration of ACEIs or ARBs reduced the risk of severe/death outcomes for COVID-19 patients. Meanwhile, a significant reduction in the risk of severe/death outcomes was observed to be associated with the administration of ACEIs or ARBs among COVID-19 patients in China, but this association was weaker for studies outside China. Furthermore, ACEI therapy was found to carry a significantly lower risk of an adverse clinical outcome.

DISCUSSION:

Our systematic review and meta-analysis found that neither ACEIs nor ARBs worsen the clinical outcomes of COVID-19 patients. On the contrary, we found that patients treated with ACEIs or ARBs have a reduced risk of severe/death outcomes, especially in Asia. Furthermore, ACEIs may reduce the risk of severe/death outcomes. Therefore, treatment interruption of ACEI or ARB therapy during COVID-19 infection is not recommended.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Drug Treatment / Hypertension Type of study: Experimental Studies / Prognostic study / Reviews / Systematic review/Meta Analysis Topics: Long Covid Limits: Adult / Humans Language: English Journal: Ann Palliat Med Year: 2022 Document Type: Article Affiliation country: Apm-21-972

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Drug Treatment / Hypertension Type of study: Experimental Studies / Prognostic study / Reviews / Systematic review/Meta Analysis Topics: Long Covid Limits: Adult / Humans Language: English Journal: Ann Palliat Med Year: 2022 Document Type: Article Affiliation country: Apm-21-972