Effect of Renin-Angiotensin-Aldosterone System Inhibitors in Patients with COVID-19: a Systematic Review and Meta-analys
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EVIDENCE-BASED MEDICINE, CLINICAL TRIALS AND THEIR INTERPRETATIONS (L. ROEVER, SECTION EDITOR)
Effect of Renin-Angiotensin-Aldosterone System Inhibitors in Patients with COVID-19: a Systematic Review and Meta-analysis of 28,872 Patients Ranu Baral 1 & Madeline White 2 & Vassilios S Vassiliou 1,2
# The Author(s) 2020
Abstract Purpose of Review The role of renin-angiotensin-aldosterone system (RAAS) inhibitors, notably angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs), 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 vs non-ACEi (OR 1.008, CI 0.822 to 1.235, p = 0.941) and ARB vs 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. Keywords Renin-angiotensin-aldosterone system . Hypertension . Coronavirus . COVID
Introduction Coronavirus disease 2019 (COVID-19), emerging from Wuhan, China, in December 2019 has quickly evolved into This article is part of the Topical Collection on Evidence-Based Medicine, Clinical Trials and Their Interpretations Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11883-020-00880-6) contains supplementary material, which is available to authorized users. * Vassilios S Vassiliou [email protected] 1
Norfolk and Norwich University Hospital, Norwich, UK
2
Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK
a global pandemic. It is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1] and affects all the organs of the body and especially the lungs. As of 20th May 2020, WHO reported 4,789,205 cases of COVID-19 worldwide and 318,789 deaths [2]. In such an unprecedented pandemic, the role of reninangiotensin-aldosterone system (RAAS) inhibitors, not
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