TY - JOUR
T1 - Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers and Mortality Among COVID-19 Patients
T2 - A Systematic Review and Meta-Analysis
AU - Kashour, Tarek
AU - Bin Abdulhak, Aref A.
AU - Tlayjeh, Haytham
AU - Hassett, Leslie C.
AU - Noman, Anas
AU - Mohsen, Ala
AU - Al-Mallah, Mouaz H.
AU - Tleyjeh, Imad M.
N1 - Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2020/11/18
Y1 - 2020/11/18
N2 - Background:Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are known to increase the expression of angiotensin converting enzyme 2 receptor, which has been shown to be the receptor for the acute severe respiratory syndrome coronavirus 2 (SARS-CoV-2).Areas of Uncertainty:Based on these observations, speculations raised the concerns that ACEIs/ARBs users would be more susceptible to SARS-CoV-2 infection and would be at higher risk for severe COVID-19 disease and death. Therefore, we systematically reviewed the literature and performed a meta-analysis of the association between prior use of ACEIs and ARBs and mortality due to COVID-19 disease.Data Sources:A comprehensive search of several databases from November 2019 to June 18, 2020 was conducted. The databases included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Web of Science, and Scopus. Medrxiv.org was also searched for unpublished data.Therapeutic Advances:Nine studies with a total of 18,833 patients infected with SARS-CoV-2 met our eligibility criteria. Prior use of ACEIs and/or ARBs was associated with reduced mortality among SARS-CoV-2-infected patients, with a pooled adjusted relative risk (aRR) from 6 studies of 0.63, 95% confidence interval (CI) (0.42-0.94) (I2= 65%). Three studies reported separately on ACEIs or ARBs and their association with survival among SARS-CoV-2-infected patients, with a pooled adjusted relative risk of 0.78, 95% CI (0.58-1.04) (I2= 0%) and 0.97, 95% CI (0.73-1.30) (I2= 0%) respectively. The results of sensitivity analyses were consistent with the main analysis.Conclusion:Our meta-analysis suggests that use of ACEIs/ARBs is associated with a decreased risk of death among SARS-CoV-2-infected patients. This finding provides a reassurance to the public not to stop prescribed ACEIs/ARBs because of fear of severe COVID-19.
AB - Background:Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are known to increase the expression of angiotensin converting enzyme 2 receptor, which has been shown to be the receptor for the acute severe respiratory syndrome coronavirus 2 (SARS-CoV-2).Areas of Uncertainty:Based on these observations, speculations raised the concerns that ACEIs/ARBs users would be more susceptible to SARS-CoV-2 infection and would be at higher risk for severe COVID-19 disease and death. Therefore, we systematically reviewed the literature and performed a meta-analysis of the association between prior use of ACEIs and ARBs and mortality due to COVID-19 disease.Data Sources:A comprehensive search of several databases from November 2019 to June 18, 2020 was conducted. The databases included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Web of Science, and Scopus. Medrxiv.org was also searched for unpublished data.Therapeutic Advances:Nine studies with a total of 18,833 patients infected with SARS-CoV-2 met our eligibility criteria. Prior use of ACEIs and/or ARBs was associated with reduced mortality among SARS-CoV-2-infected patients, with a pooled adjusted relative risk (aRR) from 6 studies of 0.63, 95% confidence interval (CI) (0.42-0.94) (I2= 65%). Three studies reported separately on ACEIs or ARBs and their association with survival among SARS-CoV-2-infected patients, with a pooled adjusted relative risk of 0.78, 95% CI (0.58-1.04) (I2= 0%) and 0.97, 95% CI (0.73-1.30) (I2= 0%) respectively. The results of sensitivity analyses were consistent with the main analysis.Conclusion:Our meta-analysis suggests that use of ACEIs/ARBs is associated with a decreased risk of death among SARS-CoV-2-infected patients. This finding provides a reassurance to the public not to stop prescribed ACEIs/ARBs because of fear of severe COVID-19.
KW - angiotensin converting enzyme
KW - blockers
KW - COVID-19
KW - inhibitors
KW - meta-analysis
KW - mortality
KW - SARS-CoV-2
KW - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
KW - COVID-19/complications
KW - Humans
KW - Cause of Death
KW - Angiotensin Receptor Antagonists/therapeutic use
KW - Hypertension/drug therapy
UR - http://www.scopus.com/inward/record.url?scp=85112558060&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85112558060&partnerID=8YFLogxK
U2 - 10.1097/MJT.0000000000001281
DO - 10.1097/MJT.0000000000001281
M3 - Article
C2 - 33201001
AN - SCOPUS:85112558060
SN - 1075-2765
VL - 30
SP - E336-E346
JO - American journal of therapeutics
JF - American journal of therapeutics
IS - 4
ER -