Baral, Ranu, White, Madeline and Vassiliou, Vassilios (2020) Effect of renin-angiotensin-aldosterone system inhibitors in patients with COVID-19: a systematic review and meta-analysis of 28,872 patients. Current Atherosclerosis Reports, 22. ISSN 1523-3804

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Abstract

Purpose of review: The role of Renin-Angiotensin-Aldosterone System (RAAS) inhibitors, notably Angiotensin-Converting Enzyme inhibitors (ACEi) or Angiotensin Receptor Blockers (ARB) 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 v Non-ACEi (OR 1.008, CI 0.822 to 1.235, p= 0.941) and ARB v 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.

Item Type:	Article
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	LivePure Connector
Date Deposited:	22 Jul 2020 02:47
Last Modified:	28 Aug 2020 23:56
URI:	https://ueaeprints.uea.ac.uk/id/eprint/76220
DOI:	10.1007/s11883-020-00880-6

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