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

Ren, Lu; Yu, Shandong; Xu, Wilson; Overton, James; Chiamvimonvat, Nipavan; Thai, Phung N.

doi:10.1016/j.jjcc.2020.10.015

Cited by 56 publications

(83 citation statements)

References 47 publications

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“…The authors investigated each of five antihypertensive classes separately. Similar results were reported in a large meta-analysis that included 2,100,587 participants ( 32 ). The investigators observed no association between prior usage of antihypertensive medications, including ACEIs/ARBs, calcium channel blockers, beta-blockers, or diuretics, and the risk or severity of COVID-19.…”

Section: Antihypertensive Therapy In Covid-19supporting

confidence: 88%

Hypertension and COVID-19: Ongoing Controversies

Tadić

Saeed

Grassı

et al. 2021

Front. Cardiovasc. Med.

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Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic responsible for millions of deaths around the world. Hypertension has been identified as one of the most common comorbidities and risk factors for severity and adverse outcome in these patients. Recent investigations have raised the question whether hypertension represents a predictor of outcome in COVID-19 patients independently of other common comorbidities such as diabetes, obesity, other cardiovascular diseases, chronic kidney, liver, and pulmonary diseases. However, the impact of chronic and newly diagnosed hypertension in COVID-19 patients has been insufficiently investigated. The same is true for the relationship between blood pressure levels and outcomes in COVID-19 patients. It seems that the long discussion about the impact of angiotensin-converting enzyme inhibitors (ACEI) and blockers of angiotensin I receptors (ARB) on severity and outcome in COVID-19 is approaching an end because the large number of original studies and meta-analyses discarded the initial findings about higher prevalence of ACEI/ARB use in patients with unfavorable outcomes. Nevertheless, there are many controversies in the relationship between hypertension and COVID-19. The aim of this review article is to provide a clinical overview of the currently available evidence regarding the predictive value of hypertension, the effect of blood pressure levels, the impact of previously known and newly diagnosed hypertension, and the effect of antihypertensive therapy on the severity and outcomes in COVID-19 patients.

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Section: Antihypertensive Therapy In Covid-19supporting

confidence: 88%

Hypertension and COVID-19: Ongoing Controversies

Tadić

Saeed

Grassı

et al. 2021

Front. Cardiovasc. Med.

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“…Promptly, in the first weeks of May, three large epidemiological studies were published supporting the lack of association between the outpatient use of RASIs and risk of COVID-19 [4-6]. Later on, a plethora of studies and meta-analyses were published [7,8] reaching the same conclusion, which provide reassurance on the safety of these drugs. Yet, the extent of RASI discontinuation at hospital admission during the first wave of the pandemic and, importantly, its impact on health outcomes have been scarcely studied [9-12].…”

Section: Introductionmentioning

confidence: 99%

In-Hospital Continuation With Angiotensin Receptor Blockers Is Associated With a Lower Mortality Rate Than Continuation With Angiotensin Converting Enzyme Inhibitors in Covid-19 Patients: A Retrospective Cohort Study

Rodríguez‐Miguel

Rodríguez‐Martín

et al. 2021

Preprint

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BackgroundSeveral studies have reported a reduced risk of death associated with the inpatient use of angiotensin receptor blockers (ARBs) and angiotensin converting enzyme inhibitors (ACEIs) in COVID-19 patients, but have been criticized for incurring in several types of bias. Also, most studies have pooled ACEIs and ARBs as if they were a unique group, overlooking their pharmacological differences. We aimed to assess whether the in-hospital continuation of ARBs and ACEIs, in regular users of these drugs, was associated with a reduced risk of death as compared to their discontinuation and also to compare head-to-head ARBs with ACEIs.MethodsAdult patients with a PCR-confirmed diagnosis of COVID-19 requiring admission during March, 2020 were consecutively selected from 7 hospitals in Madrid, Spain. Among them, we identified outpatient users of ACEIs/ARBs and divided them in two cohorts depending on treatment discontinuation/continuation at admission. Then, they were followed-up until discharge or in-hospital death. An intention-to-treat survival analysis was carried out and hazard ratios (HRs) and their 95%CI were computed through a Cox regression model adjusted for propensity scores of discontinuation and controlled by potential mediators.ResultsOut of 625 ACEI/ARB users, 340(54.4%) discontinued treatment. The in-hospital mortality rates were 27.6% and 27.7% in discontinuation and continuation cohorts, respectively (HR=1.01; 95%CI:0.70-1.46). No difference in mortality was observed between ARB and ACEI discontinuation (28.6% vs. 27.1%, respectively), while a significantly lower mortality rate was found among patients who continued with ARBs (20.8%,N=125) as compared to those who continued with ACEIs (33.1%,N=136; p=0.03). The head-to-head comparison (ARB vs. ACEI continuation) yielded an adjusted HR of 0.52 (95%CI:0.29-0.93), being especially notorious among males (HR=0.34; 95%CI:0.12-0.93), subjects older than 74 years (HR=0.46; 95%CI:0.25-0.85), and patients with obesity (HR=0.22; 95%CI:0.05-0.94), diabetes (HR=0.36; 95%CI:0.13-0.97) and heart failure (HR=0.12; 95%CI:0.03-0.97).ConclusionsAmong regular users of ARBs admitted for COVID-19, the in-hospital continuation with them was associated with an improved survival, while this was not observed with ACEIs. Regular users of ARBs should continue with this treatment if admitted for COVID-19, unless medically contraindicated. In admitted ACEI users, a switching to ARBs should be considered, especially among high-risk patients.GRAPHICAL ABSTRACT

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“…New evidence since the publication of our original review includes results from a randomized controlled trial and 4 large database studies that included patients with a mix of disease severity ( 16–19 , 23 ). These studies consistently found that ACEI or ARB use was not associated with a higher risk for SARS-CoV-2 infection, findings which are further supported by 5 systematic reviews or meta-analyses ( 11 , 14 , 92–94 ). Because we consider these findings to be stable (meaning that future studies are likely to have the same results), we will no longer do literature surveillance on this KQ and will retire it from our living review.…”

Section: Key Question 1: Does the Use Of Aceis And Arbs Before Infectmentioning

confidence: 59%

“…These studies are all relevant to key question (KQ) 2 about the association of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB) use and coronavirus disease 2019 (COVID-19) severity, and they support our prior conclusion that ACEI or ARB use is not associated with a higher risk for severe COVID-19 illness. Two systematic reviews also address KQ1, adding support to our prior conclusion that ACEI or ARB use is not associated with an increased risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection ( 11 , 14 ).…”

mentioning

confidence: 72%

Update Alert 7: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults

2021

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

Abstract: Highlights The usage of antihypertensive drugs is not associated with the risk and severity of COVID-19. Hypertensive patients with COVID-19 benefit from prior usage of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers.

Cited by 56 publications

References 47 publications

Hypertension and COVID-19: Ongoing Controversies

Hypertension and COVID-19: Ongoing Controversies

In-Hospital Continuation With Angiotensin Receptor Blockers Is Associated With a Lower Mortality Rate Than Continuation With Angiotensin Converting Enzyme Inhibitors in Covid-19 Patients: A Retrospective Cohort Study

Update Alert 7: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults

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