Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial

Ecological Analysis of the Influence of ACEIs and ARBs on the COVID-19 Prevalence and Death from COVID-19

“…Cohen et al reported that discontinuation of RAAS inhibitors in patients who have been using RAAS inhibitors prior to hospitalization does not influence the disease outcome. This result certainly is reassuring to medical communities and to patients who are on RAAS inhibitors but keep in mind that this is a small trial, where only a total of 152 patients were included [38]. Given that the COVID-19 pandemic is already entering the third waves, showing no signs to cease soon and that there are still many people taking RAAS inhibitors to control cardiovascular risks, role of RAAS inhibitors in COVID-19 diseases should be carefully assessed and recommendations to continuously using RAAS inhibitors during COVID-19 may require reconsiderations.…”

Hospital mortality in COVID-19 patients in Belgium treated with statins, ACE inhibitors and/or ARBs

“…We did not have information on whether our treated COVID-19 inpatients had also been treated as outpatients, although it is likely that many who had been treated as outpatients continued their treatment after hospital admission. However, several individual studies [e.g., [68][69][70][71][72] and meta-analyses [73,74] of statin treatment have yielded conflicting results. In these studies, treatment was ascertained largely on the basis of outpatient (not inpatient) information.…”

Renin–angiotensin system inhibitor use and the risk of mortality in hospitalized patients with COVID-19: a meta-analysis of randomized controlled trials

“…Four randomized controlled trials [ 11 – 14 ] were included after screening, with a total of 488 patients who were randomized to the use of RAS inhibitors during hospitalization for COVID-19 and 475 patients who were randomized to the control group and did not receive RAS inhibitors during hospitalization for COVID-19. Specifically, two trials [ 11 , 12 ] investigated the continued use of RAS inhibitors versus the discontinuation of RAS inhibitors, while the other two trials [ 13 , 14 ] evaluated the effect of the de novo introduction of RAS inhibitors (telmisartan and losartan, respectively) versus standard care and amlodipine, respectively, among patients hospitalized for COVID-19. Three of the included randomized trials in the meta-analysis were from Brazil [ 11 ], Argentina [ 13 ], and Iran [ 14 ], whereas the remaining randomized trial [ 12 ] was an international multicenter study performed in seven countries.…”

“…Specifically, two trials [ 11 , 12 ] investigated the continued use of RAS inhibitors versus the discontinuation of RAS inhibitors, while the other two trials [ 13 , 14 ] evaluated the effect of the de novo introduction of RAS inhibitors (telmisartan and losartan, respectively) versus standard care and amlodipine, respectively, among patients hospitalized for COVID-19. Three of the included randomized trials in the meta-analysis were from Brazil [ 11 ], Argentina [ 13 ], and Iran [ 14 ], whereas the remaining randomized trial [ 12 ] was an international multicenter study performed in seven countries. Details of the included studies and the overall risk of bias assessed by RoB 2 are depicted in Table 1 .…”

“…Details of the included studies and the overall risk of bias assessed by RoB 2 are depicted in Table 1 . In terms of the risk of bias, all the included trials had some concerns with regard to the overall risk of bias; the trials by Lopes et al [ 11 ], Cohen et al [ 12 ], and Duarte et al [ 13 ] had some concerns over the risk of bias in the domain of “deviations from intended interventions” because of their open-label trial design, whereas the trial by Nouri-Vakesh et al [ 14 ] had some concerns over the risk of bias in the domain of “selection of the reported results” due to the possibility that the trial was not anlyzed as pre-specified.…”