ABSTRACT
ObjectiveThe association between renin-angiotensin-aldosterone (RAAS) inhibitors and Coronavirus diseases 2019 (COVID-19) mortality is unclear. We aimed to explore the association of RAAS inhibitors, including angiotensin-converting inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) with COVID-19 mortality in patients with hypertension. MethodsMEDLINE, SCOPUS, OVID, and Cochrane Library were searched for the period of January 1, 2020 to May 20, 2020. Studies reporting the association of RAAS inhibitors (ACEi and ARBs) and mortality in patients with hypertension, hospitalized for COVID-19 were extracted. Two reviewers independently extracted appropriate data of interest and assessed the risk of bias. All analyses were performed using random-effects models on log-transformed risk ratio estimates, and heterogeneity was quantified. ResultsData were collected on 2,065,805 individuals (mean age, 58.73 years; 53.4% male). Patients with hypertension taking RAAS inhibitors were 35% less likely to die from COVID-19 compared to patients with hypertension not taking RAAS inhibitors (pooled RR= 0.65, 95% Confidence Intervals (CI): 0.45-0.94). To explore the association of COVID-19 and specific classes of RAAS inhibitors, we conducted a subgroup analysis of ARBs and ACEi separately from studies that provided them. Pooled risk ratio estimates from ARBs and ACEi showed a lower but not significant risk of death from COVID-19 (RR=0.93, 95% CI: 0.70-1.22) and ACEi (RR=0.65, 95% CI: 0.32-1.30). ConclusionsIn this meta-analysis, it was discovered that taking RAAS inhibitors, significantly decreased the risk of COVID-19 mortality in patients with hypertension. This indicates a potential protective role that RAAS-inhibitors may have in COVID-19 patients with hypertension. Key QuestionsO_ST_ABSWhat is already known about this subject?C_ST_ABSSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the recent coronavirus disease 2019 (COVID-19) pandemic, interfaces with the renin-angiotensin-aldosterone system (RAAS) through angiotensin-converting enzyme 2 (ACE2). Recent studies have questioned whether RAAS inhibitors are safe in patients with COVID-19. However, observational studies involving patients hospitalized with COVID-19 that report the association of RAAS-inhibitors and COVID-19 severity or death have yielded conflicting findings. What does this study add?This systematic review and meta-analysis discovered that RAAS inhibitors reduced the risk of mortality by 35% in patients with hypertension hospitalized for COVID-19 (RR= 0.65, 95% CI 0.45-0.94). How might this impact clinical practice?Patients taking RAAS-inhibitors to manage their hypertension should continue to do as per current treatment guidelines.
