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Renin-Angiotensin System Inhibitors and COVID-19: a Systematic Review and Meta-Analysis. Evidence for Significant Geographical Disparities.
Curr Hypertens Rep. 2020 09 10; 22(11):90.CH

Abstract

PURPOSE OF REVIEW

While the COVID-19 pandemic is constantly evolving, it remains unclear whether the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) affects the clinical course of SARS-CoV-2 infection. For this meta-analysis, PubMed, CENTRAL, and grey literature were searched from their inception to 19 May 2020 for randomized, controlled trials or observational studies that evaluate the association between the use of either ACE inhibitors or ARBs and the risk for major clinical endpoints (infection, hospitalization, admission to ICU, death) in adult patients during the COVID-19 pandemic. In addition, a subgroup geographical analysis of outcomes was performed. Studies including less than 100 subjects were excluded from our analysis.

RECENT FINDINGS

In total, 25 observational studies were included. ACE inhibitors and ARBs were not associated with increased odds for SARS-CoV-2 infection, admission to hospital, severe or critical illness, admission to ICU, and SARS-CoV-2-related death. In Asian countries, the use of ACE inhibitors/ARBs decreased the odds for severe or critical illness and death (OR = 0.37, 95% CI 0.16-0.89, I2 = 83%, and OR = 0.62, 95% CI 0.39-0.99, I2 = 0%, respectively), whereas they increased the odds for ICU admission in North America and death in Europe (OR = 1.75, 95% CI 1.37-2.23, I2 = 0%, and OR = 1.68, 95% CI 1.05-2.70, I2 = 82%, respectively). ACE inhibitors might be marginally protective regarding SARS-CoV-2-related death compared with ARBs (OR = 0.86, 95% CI 0.74-1.00, I2 = 0%). Randomized controlled trials are needed to confirm the aforementioned associations between ACE inhibitors, ARBs, and SARS-CoV-2.

Authors+Show Affiliations

Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Konstantinoupoleos 49, 54 642, Thessaloniki, Greece.Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Konstantinoupoleos 49, 54 642, Thessaloniki, Greece.Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Konstantinoupoleos 49, 54 642, Thessaloniki, Greece.Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Konstantinoupoleos 49, 54 642, Thessaloniki, Greece.Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Konstantinoupoleos 49, 54 642, Thessaloniki, Greece.Second Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital "Hippokration", Konstantinoupoleos 49, 54 642, Thessaloniki, Greece. michalisdoumas@yahoo.co.uk.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

32910274

Citation

Patoulias, Dimitrios, et al. "Renin-Angiotensin System Inhibitors and COVID-19: a Systematic Review and Meta-Analysis. Evidence for Significant Geographical Disparities." Current Hypertension Reports, vol. 22, no. 11, 2020, p. 90.
Patoulias D, Katsimardou A, Stavropoulos K, et al. Renin-Angiotensin System Inhibitors and COVID-19: a Systematic Review and Meta-Analysis. Evidence for Significant Geographical Disparities. Curr Hypertens Rep. 2020;22(11):90.
Patoulias, D., Katsimardou, A., Stavropoulos, K., Imprialos, K., Kalogirou, M. S., & Doumas, M. (2020). Renin-Angiotensin System Inhibitors and COVID-19: a Systematic Review and Meta-Analysis. Evidence for Significant Geographical Disparities. Current Hypertension Reports, 22(11), 90. https://doi.org/10.1007/s11906-020-01101-w
Patoulias D, et al. Renin-Angiotensin System Inhibitors and COVID-19: a Systematic Review and Meta-Analysis. Evidence for Significant Geographical Disparities. Curr Hypertens Rep. 2020 09 10;22(11):90. PubMed PMID: 32910274.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Renin-Angiotensin System Inhibitors and COVID-19: a Systematic Review and Meta-Analysis. Evidence for Significant Geographical Disparities. AU - Patoulias,Dimitrios, AU - Katsimardou,Alexandra, AU - Stavropoulos,Konstantinos, AU - Imprialos,Konstantinos, AU - Kalogirou,Maria-Styliani, AU - Doumas,Michael, Y1 - 2020/09/10/ PY - 2020/08/20/accepted PY - 2020/9/10/entrez PY - 2020/9/11/pubmed PY - 2020/9/20/medline KW - ACE inhibitors KW - ARBs KW - Angiotensin receptor blockers KW - Angiotensin-converting enzyme inhibitors KW - COVID-19 KW - Hypertension KW - RAS inhibitors KW - Renin-angiotensin inhibitors KW - SARS-CoV-2 SP - 90 EP - 90 JF - Current hypertension reports JO - Curr Hypertens Rep VL - 22 IS - 11 N2 - PURPOSE OF REVIEW: While the COVID-19 pandemic is constantly evolving, it remains unclear whether the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) affects the clinical course of SARS-CoV-2 infection. For this meta-analysis, PubMed, CENTRAL, and grey literature were searched from their inception to 19 May 2020 for randomized, controlled trials or observational studies that evaluate the association between the use of either ACE inhibitors or ARBs and the risk for major clinical endpoints (infection, hospitalization, admission to ICU, death) in adult patients during the COVID-19 pandemic. In addition, a subgroup geographical analysis of outcomes was performed. Studies including less than 100 subjects were excluded from our analysis. RECENT FINDINGS: In total, 25 observational studies were included. ACE inhibitors and ARBs were not associated with increased odds for SARS-CoV-2 infection, admission to hospital, severe or critical illness, admission to ICU, and SARS-CoV-2-related death. In Asian countries, the use of ACE inhibitors/ARBs decreased the odds for severe or critical illness and death (OR = 0.37, 95% CI 0.16-0.89, I2 = 83%, and OR = 0.62, 95% CI 0.39-0.99, I2 = 0%, respectively), whereas they increased the odds for ICU admission in North America and death in Europe (OR = 1.75, 95% CI 1.37-2.23, I2 = 0%, and OR = 1.68, 95% CI 1.05-2.70, I2 = 82%, respectively). ACE inhibitors might be marginally protective regarding SARS-CoV-2-related death compared with ARBs (OR = 0.86, 95% CI 0.74-1.00, I2 = 0%). Randomized controlled trials are needed to confirm the aforementioned associations between ACE inhibitors, ARBs, and SARS-CoV-2. SN - 1534-3111 UR - https://www.unboundmedicine.com/medline/citation/32910274/Renin_Angiotensin_System_Inhibitors_and_COVID_19:_a_Systematic_Review_and_Meta_Analysis__Evidence_for_Significant_Geographical_Disparities_ L2 - https://dx.doi.org/10.1007/s11906-020-01101-w DB - PRIME DP - Unbound Medicine ER -