Effect of Renin-Angiotensin-Aldosterone System Inhibitors in Patients with COVID-19: a Systematic Review and Meta-analysis of 28,872 Patients

Abstract

Purpose of Review The role of renin-angiotensin-aldosterone system (RAAS) inhibitors, notably angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs), in the COVID-19 pandemic has not been fully evaluated. With an increasing number of COVID-19 cases worldwide, it is imperative to better understand the impact of RAAS inhibitors in hypertensive COVID patients. PubMed, Embase and the pre-print database Medrxiv were searched, and studies with data on patients on ACEi/ARB with COVID-19 were included. Random effects models were used to estimate the pooled mean difference with 95% confidence interval using Open Meta[Analyst] software. Recent Findings A total of 28,872 patients were included in this meta-analysis. The use of any RAAS inhibition for any conditions showed a trend to lower risk of death/critical events (OR 0.671, CI 0.435 to 1.034, p = 0.071). Within the hypertensive cohort, however, there was a significant lower association with deaths (OR 0.664, CI 0.458 to 0.964, p = 0.031) or the combination of death/critical outcomes (OR 0.670, CI 0.495 to 0.908, p = 0.010). There was no significant association of critical/death outcomes within ACEi vs non-ACEi (OR 1.008, CI 0.822 to 1.235, p = 0.941) and ARB vs non-ARB (OR 0.946, CI 0.735 to 1.218, p = 0.668). Summary This is the largest meta-analysis including critical events and mortality data on patients prescribed ACEi/ARB and found evidence of beneficial effects of chronic ACEi/ARB use especially in hypertensive cohort with COVID-19. As such, we would strongly encourage patients to continue with RAAS inhibitor pharmacotherapy during the COVID-19 pandemic. Electronic supplementary material The online version of this article (10.1007/s11883-020-00880-6) contains supplementary material, which is available to authorized users.

Comorbidities in rheumatic diseases need special consideration during the COVID-19 pandemic

“…Currently, there is ample evidence that the use of angiotensin-converting enzyme (ACE) inhibitors and ACE-receptor blockers in patients with hypertension help in reducing both COVID-19 severity and mortality [ 123 ]. A good number of meta-analyses have been carried out looking at the effects of renin–angiotensin inhibitors in COVID-19, and now there is sufficient proof that the use of ACE-inhibitors for any indication reduces mortality in COVID-19 [ 124 ].…”

Pharmacological treatment of COVID-19: an update

“…120,121 A recent meta-analysis of >28000 patients who were already on these medications had a lower risk of death from COVID-19 compared to patients who were not on these medications. 122 This study also added to the growing body of evidence that the use of ACEi/ARB does not have any association with the severity of disease or even death among patients admitted with COVID-19. The effect of commencing treatment with ACEi/ARBs in patients diagnosed with COVID-19 who were previously not on these medications has not been studied.…”

Herz-Kreislauf-Erkrankungen und COVID-19

“… Für blutdrucksenkende Medikamente wie ACE-Hemmer und AT1-Blocker zeigte die Brace-Corona-Studie, eine prospektiv randomisierte Studie mit 659 SARS-CoV-2-Patienten, die bereits ACE-Hemmer oder AT1-Blocker einnahmen, dass es keinen Unterschied zwischen der Gruppe, die ACE-Hemmer oder AT1-Blocker absetzte und derjenigen, die die Einnahme unverändert fortsetzte, gibt. Neuere Metaanalysen deuten sogar auf potenzielle Überlebensvorteile von mit ACE-Hemmern/AT1-Blockern behandelten hypertensiven COVID-19-Patienten hin [ 1 , 2 ]. Die Deutsche Gesellschaft für Kardiologie hat bereits früh eine Stellungnahme hierzu verfasst und empfohlen, Therapien mit ACE-Hemmern und AT1-Blockern fortzuführen.…”

“…Nach anfänglichen Bedenken bezüglich potenziell negativer Effekte antihypertensiver Therapien mit ACE-Inhibitoren (ACE-I) oder AT1(Angiotensin-II-Rezeptor Subtyp 1)-Antagonisten (Angiotensinrezeptorblocker, ARB) zeigen nun mehrere Studien, dass beide Medikamentengruppen vermutlich positive Effekte bei COVID-19-Patienten haben (Abb. 1 ; [ 1 , 2 ]).

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