Comparative Impacts of ACE (Angiotensin-Converting Enzyme) Inhibitors Versus Angiotensin II Receptor Blockers on the Risk of COVID-19 Mortality

Zhou, Feng; Liu, Ye Mao; Xie, Jing; Li, Haomiao; Lei, Fang; Yang, Huilin; Qin, Juan Juan; Cai, Jingjing; Zhang, Xiao Jing; Wu, Bin; Meng, Xiaomei; Da, Xiang; Yang, Chengzhang; Ma, Xin‐Liang; Xu, Qingbo; Lu, Zhigang; Lu, Haofeng; Xia, Xin; Wang, Daihong; Liao, Xiaofeng; Peng, Gang; Yang, Jun; Huang, Xiaodong; Zhang, Bing Hong; Yuan, Yufeng; Xiang, Wei; Liu, Peter P.; Wang, Yibin; Zhang, Peng; She, Zhi Gang; Xia, Jiahong; Li, Hongliang

doi:10.1161/hypertensionaha.120.15622

Cited by 58 publications

(66 citation statements)

References 5 publications

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“…One of the three reports published in Hypertension demonstrating similar conclusion as our report here. However, this study reported in a short communication with only 1 figure without detailed methodology 47 . Two reports published in JAMA and JAMA Cardiology and one retracted NEJM paper show that ARBs were not statistically significantly associated with fatal outcome of COVID-19 32 , 42 , 48 .…”

Section: Discussionmentioning

confidence: 84%

“…There are 18 reports studying the association of ARBs and ACEI drugs with COVID-19 26 , 29 , 32 – 47 . Eleven out of the 18 papers reported the analysis of fatal outcome.…”

Section: Discussionmentioning

confidence: 99%

“…A more rigorous analysis would be to calculate the COVID-19 association of ARBs and ACEI separately. The other three articles included separated ARBs users’ group 32 , 42 , 47 . One of the three reports published in Hypertension demonstrating similar conclusion as our report here.…”

Section: Discussionmentioning

confidence: 99%

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Antihypertensive drugs are associated with reduced fatal outcomes and improved clinical characteristics in elderly COVID-19 patients

Yan

Huang

et al. 2020

Cell Discov

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The novel coronavirus (CoV) severe acute respiratory syndrome (SARS)-CoV-2 outbreak began at the end of 2019 in Wuhan, China, and has spread to over 200 countries. In this multicenter retrospective study, we identified 2190 adult patients admitted for laboratory-confirmed COVID-19 in three participating centers. Multivariate logistic regression was conducted in patients with comorbid hypertension to examine the potential association between clinical outcomes, disease severity, and clinical characteristics with the use of ACEI, ARB, calcium-channel blockers (CCB), beta-blockers (BB), and thiazide diuretics. The clinical outcome, dyspnea, and fatigue were significantly improved in patients, especially elderly patients who were older than 65 years, who took ARB drugs prior to hospitalization compared to patients who took no drugs. The reduction of disease severity of elderly COVID-19 patients was associated with CCB and ACEI users. Clinical indices, including CRP, lymphocyte count, procalcitonin D dimer, and hemoglobin, were significantly improved in elderly ARB users. In addition, the clinical outcomes were statistically significantly improved in patients who took antihypertension drugs ARB, BB, and CCB after statistical adjustment by all ages, gender, baseline of blood pressures, and coexisting medical conditions. Our data indicate that hypertension drugs ARB, ACEI, CCB, and BB might be beneficial for COVID-19 patients.

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Section: Discussionmentioning

confidence: 84%

“…There are 18 reports studying the association of ARBs and ACEI drugs with COVID-19 26 , 29 , 32 – 47 . Eleven out of the 18 papers reported the analysis of fatal outcome.…”

Section: Discussionmentioning

confidence: 99%

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Antihypertensive drugs are associated with reduced fatal outcomes and improved clinical characteristics in elderly COVID-19 patients

Yan

Huang

et al. 2020

Cell Discov

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“…2; pooled OR = 0.73, 95% CI 0.56-0.95). In a separate pooled analysis of 11 studies that provided adjusted HRs, with 26,598 COVID-19 patients being analyzed [36,54,56,57,59,67,69,70,72,74,77], the use of an ACEI/ARB was significantly associated with lower risk of mortality compared to the non-use of an ACEI/ARB (Supplementary Figure S1; pooled HR = 0.75, 95% CI 0.60-0.95). The funnel plot was used to detect the publication bias and revealed some degree of asymmetry (Supplementary Figure S3 and S4).…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Subgroup analysis that was limited to studies that provided adjusted mortality estimates for exclusively hypertensive patients with COVID-19 demonstrated a statistically non-significant association with lower odds of mortality (Supplementary Table S2; pooled OR = 0.73, 95% CI 0.52-1.02; six studies [66,75,78,88,89,92]) and a statistically significant association with lower risk of mortality (Supplementary Table S2; pooled HR = 0.39, 95% CI 0.20-0.77; five studies [36,54,56,57,72]) among users of ACEIs/ARBs compared to the non-users. Table S2; pooled OR = 0.89, 95% CI 0.66-1.21) [86,88,89,92] in the users of ACEIs/ARBs compared to the non-users.…”

Section: Mortality Associated With the Use Of Ras Inhibitors In Covidmentioning

confidence: 99%

Mortality and Disease Severity Among COVID-19 Patients Receiving Renin-Angiotensin System Inhibitors: A Systematic Review and Meta-analysis

Hasan

Kow

Hadi

et al. 2020

Am J Cardiovasc Drugs

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Introduction The use of renin-angiotensin system (RAS) inhibitors, including angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), was alleged to cause a more severe course of novel coronavirus disease 2019 (COVID-19). Methods We systematically reviewed the published studies to assess the association of RAS inhibitors with mortality as well as disease severity in COVID-19 patients. A systematic literature search was performed to retrieve relevant original studies investigating mortality and severity (severe/critical disease) in COVID-19 patients with and without exposure to RAS inhibitors. Results A total of 59 original studies were included for qualitative synthesis. Twenty-four studies that reported adjusted effect sizes (24 studies reported mortality outcomes and 16 studies reported disease severity outcomes), conducted in RAS inhibitor-exposed and unexposed groups, were pooled in random-effects models to estimate overall risk. Quality assessment of studies revealed that most of the studies included were of fair quality. The use of an ACEI/ARB in COVID-19 patients was significantly associated with lower odds (odds ratio [OR] = 0.73, 95% confidence interval [CI] 0.56-0.95; n = 18,749) or hazard (hazard ratio [HR] = 0.75, 95% CI 0.60-0.95; n = 26,598) of mortality compared with non-use of ACEI/ARB. However, the use of an ACEI/ARB was non-significantly associated with lower odds (OR = 0.91, 95% CI 0.75-1.10; n = 7446) or hazard (HR = 0.73, 95% CI 0.33-1.66; n = 6325) of developing severe/critical disease compared with non-use of an ACEI/ARB. Discussion Since there was no increased risk of harm, the use of RAS inhibitors for hypertension and other established clinical indications can be maintained in COVID-19 patients.

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Association Between Renin-Angiotensin-Aldosterone System Inhibitors and Clinical Outcomes in Patients With COVID-19

et al. 2021

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Key Points Question Is the receipt of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) associated with worse clinical outcomes among patients with COVID-19? Findings In this systematic review and meta-analysis of 52 studies that evaluated clinical outcomes among 101 949 total patients with COVID-19 who did and did not receive ACEIs or ARBs, a significantly lower risk of multivariable-adjusted mortality and severe adverse events was found among patients who received ACEIs or ARBs compared with patients who did not. A subgroup analysis of patients with hypertension indicated significant decreases in mortality and severe adverse events among patients receiving ACEIs or ARBs in both unadjusted and adjusted analyses. Meaning The study’s findings suggest that ACEIs and ARBs may be associated with protective benefits for patients with COVID-19 and that patients may continue receiving ACEIs and ARBs for the treatment of any condition without an increased risk of worse outcomes unless specifically advised to avoid them by treating clinicians.

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Comparative Impacts of ACE (Angiotensin-Converting Enzyme) Inhibitors Versus Angiotensin II Receptor Blockers on the Risk of COVID-19 Mortality

Abstract: N/A

Cited by 58 publications

References 5 publications

Antihypertensive drugs are associated with reduced fatal outcomes and improved clinical characteristics in elderly COVID-19 patients

Antihypertensive drugs are associated with reduced fatal outcomes and improved clinical characteristics in elderly COVID-19 patients

Mortality and Disease Severity Among COVID-19 Patients Receiving Renin-Angiotensin System Inhibitors: A Systematic Review and Meta-analysis

Association Between Renin-Angiotensin-Aldosterone System Inhibitors and Clinical Outcomes in Patients With COVID-19

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