ACEI/ARB therapy should be continued in COVID-19 patients

Objectives:
An association among the use of angiotensin converting enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARBs) with the clinical outcomes of coronavirus disease 2019 (COVID-19) is unclear. Therefore, this review article has been conducted.

Have ACEI/ARB therapy beneficial effects on patients who are at risk for, or have COVID-19, either in general population or hypertension patients?

Study design:
This review article included 11 studies with 33,483 COVID-19 patients.

Results and conclusions:   
The investigators found meta-analysis showed no significant increase in the risk of COVID-19 infection [OR = 0.95, 95% CI = 0.89 to 1.05, p = 0.14, I2 = 0%] in patients receiving ACEI/ARB therapy.

The investigators found ACEI/ARB therapy was associated with a significantly decreased risk of 25% for severe COVID-19 [OR = 0.75, 95% CI = 0.59 to 0.96, p = 0.02, I2 = 54%] and a significantly decreased risk of 48% for mortality [OR = 0.52, 95% CI = 0.35 to 0.79, p = 0.002, I2 = 46%].

The investigators found subgroup analyses showed among the general population, ACEI/ARB therapy was associated with a significantly reduced risk of 69% for all-cause mortality [OR = 0.31, 95% CI = 0.13 to 0.75].

The investigators found subgroup analyses showed among patients with hypertension, the use of an ACEI/ARB was associated a significantly reduced risk of 43% for mortality [OR = 0.57, 95% CI = 0.37 to 0.87], without evidence of an increased risk of COVID-19 infection [OR = 1.00].

The investigators concluded on the basis of the available evidence, ACEI/ARB therapy should be continued in patients who are at risk for, or have COVID-19, either in general population or hypertension patients. However, these results need to be interpreted with caution considering the potential for residual confounders and more well-designed studies that control the clinical confounders are necessary to confirm these findings.  

Original title:
Association of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers with risk of COVID-19, inflammation level, severity, and death in patients with COVID-19: A rapid systematic review and meta-analysis by Liu X, Long C, […], Hong K.

Link:
https://onlinelibrary.wiley.com/doi/full/10.1002/clc.23421

Additional information of El Mondo:
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