Association of angiotensin‐converting enzyme inhibitors and angiotensin‐receptor blockers with risk of mortality, severity or SARS‐CoV‐2 test positivity in COVID‐19 patients: meta‐analysis

03, March 2021 |

Authors:

Abstract

The effects of angiotensin‐converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in the treatment of COVID‐19 are highly debated. This study was aimed to assess aggregated risk by investigating the association of ACEIs/ARBs users against non‐users of ACEIs/ARBs with the risk of mortality or severe clinical manifestations or magnitude of SARS‐CoV‐2 test positivity in COVID‐19 patients. Systematic literature search was carried out in different databases for eligible studies. The pooled relative risks (RRs) were measured using RevMan software where P<0.05 was set as statistical significance. In total, 10 studies were included in this analysis. After pooled estimation, it was demonstrated that SARS‐CoV‐2 positive patients taking ACEIs/ARBs were not associated with an increased risk of mortality compared to those not taking ACEIs/ARBs (RR 0.89; 95% CI 0.64–1.23; P=0.48). Furthermore, the risk of composite severe clinical manifestations was not significantly different between the positive patients with or without ACEIs/ARBs users (RR 1.29; 95% CI 0.81–2.04; P=0.28). There was no risk difference for SARS‐CoV‐2 test positivity in patients with or without ACEIs/ ARBs users (RR 1.00; 95% CI 0.95–1.05; P=0.91). These findings may augment current professional society guidelines for not discontinuing ACEIs/ARBs in treating COVID‐19 patients where it is clinically indicated.