Decreased Mortality of COVID-19 With Renin-Angiotensin-Aldosterone System Inhibitors Therapy in Patients With Hypertension

Abstract

The coronavirus disease 2019 (COVID-19) is caused by the infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), having gradually developed into a pandemic and endangered global health. The continued use of angiotensin converting enzyme inhibitor (ACEIs) and angiotensin II receptor blockers (ARBs) which are part of renin-angiotensin-aldosterone system (RAAS) inhibitors in COVID-19 patients with hypertension has become controversial. We conducted a meta-analysis by searching Pubmed, Web of Science, Scopus and Embase up to 13 May 2020. Data analyses were performed by the Cochrane Collaboration's Review Manager 5.3 software. Finally, we included 9 studies comprising 3936 patients with hypertension and COVID-19 infection. Compared with non-ACEI/ARB treatment, ACEI/ARB treatment was not associated with disease severity (OR 0.71, 95 % CI 0.46-1.08, P 0.11, I 2 59%) but was related to lower mortality of COVID-19 in patients with hypertension (OR 0.57, 95 % CI 0.38-0.84, P 0.004, I 2 0). In summary, ACEI/ARB therapy did not aggravate disease severity of COVID-19. Besides, ACEI/ARB therapy can decrease the mortality of COVID-19. Current evidence suggested that RAAS inhibitors should be continued in COVID-19 patients with hypertension. Future well-designed randomized controlled trials are needed to confirm these findings.

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

“…We observed a significantly lower risk of mortality in COVID-19 ACEI/ ARB users in our subgroup meta-analyses that were limited to studies that provided adjusted mortality estimates for exclusively hypertensive patients. These findings are in line with two previously reported unadjusted meta-analyses in COVID-19 hypertensive patients [102,103]. However, another meta-analysis [97] reported no significant association between the use of ACEIs/ARBs and mortality among COVID-19 patients with hypertension where the authors pooled mortality estimates without adjustment of covariates.…”

Lack of association of antihypertensive drugs with the risk and severity of COVID-19: A meta-analysis

“…Our current study provides several advantages relative to previous meta-analysis studies [ [26] , [27] , [28] , [29] , [30] , [31] ]. In contrast to previous meta-analysis studies, which analyzed approximately 9-16 records, our study included 53 records to generate a large dataset.…”

Adverse impact of renin-angiotensin system blockade on the clinical course in hospitalized patients with severe COVID-19: a retrospective cohort study

“…However, the conclusion regarding the use of RAS blockade in COVID-19 is still inconsistent, even among several meta-analyses. Most meta-analyses have reported that ACE-I and ARB use was not associated with mortality [17][18][19] , but one showed a relationship between ACE-Is and ARBs and lower mortality among hypertensive COVID-19 patients 17 . Another meta-analysis reported an overall protective effect of RAS blockade with death and critical disease 20 .…”