Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors in COVID-19: Meta-analysis/Meta-regression Adjusted for Confounding Factors (original) (raw)
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2020
OBJECTIVE: This living systematic review aims to provide a timely, rigorous and continuously updated summary of the evidence available on the role of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) in the treatment of patients with COVID-19. DESIGN: This is the protocol of a living systematic review. DATA SOURCES: We will conduct searches in PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), grey literature and in a centralised repository in L·OVE (Living OVerview of Evidence). L·OVE is a platform that maps PICO questions to evidence from Epistemonikos database. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customised to group all COVID-19 evidence in one place. The search will cover the period until the day before submission to a journal. ELEGIBILITY CRITERIA FOR SELECTING STUDIES AND METHODS: We adapted an already published common protocol for multiple...
Journal of Cardiovascular Pharmacology and Therapeutics
Background: Speculations whether treatment with angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARB) predisposes to severe coronavirus disease 2019 (COVID-19) or worsens its outcomes. This study assessed the association of ACE-I/ARB therapy with the development of severe COVID-19. Methods: This multi-center, prospective study enrolled patients hospitalized for COVID-19 and receiving one or more antihypertensive agents to manage either hypertension or cardiovascular disease. ACE-I/ARB therapy associations with severe COVID-19 on the day of hospitalization, intensive care unit (ICU) admission, mechanical ventilation and in-hospital death on follow-up were tested using a multivariate logistic regression model adjusted for age, obesity, and chronic illnesses. The composite outcome of mechanical ventilation and death was examined using the adjusted Cox multivariate regression model. Results: Of 338 enrolled patients, 245 (72.4%) were using ACE-I/ARB ...
Frontiers of Medicine, 2020
The possible effects of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) on COVID-19 disease severity have generated considerable debate. We performed a single-center, retrospective analysis of hospitalized adult COVID-19 patients in Wuhan, China, who had definite clinical outcome (dead or discharged) by February 15, 2020. Patients on anti-hypertensive treatment with or without ACEI/ARB were compared on their clinical characteristics and outcomes. The medical records from 702 patients were screened. Among the 101 patients with a history of hypertension and taking at least one anti-hypertensive medication, 40 patients were receiving ACEI/ARB as part of their regimen, and 61 patients were on antihypertensive medication other than ACEI/ARB. We observed no statistically significant differences in percentages of in-hospital mortality (28% vs. 34%, P = 0.46), ICU admission (20% vs. 28%, P = 0.37) or invasive mechanical ventilation (18% vs. 26%, P = 0.31) between patients with or without ACEI/ARB treatment. Further multivariable adjustment of age and gender did not provide evidence for a significant association between ACEI/ARB treatment and severe COVID-19 outcomes. Our findings confirm the lack of an association between chronic receipt of reninangiotensin system antagonists and severe outcomes of COVID-19. Patients should continue previous antihypertensive therapy until further evidence is available.
2020
Supplemental Material, Appendix for Association of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Blockers With Severity of COVID-19: A Multicenter, Prospective Study by Hakeam A. Hakeam, Muhannad Alsemari, Zainab Al Duhailib, Leen Ghonem, Saad A. Alharbi, Eid Almutairy, Nader M. Bin Sheraim, Meshal Alsalhi, Ali Alhijji, Sara AlQahtani, Mohammed Khalid and Mazin Barry in Journal of Cardiovascular Pharmacology and Therapeutics
BMJ, 2022
Objective To determine whether disrupting the renin angiotensin system with angiotensin receptor blockers will improve clinical outcomes in people with covid-19. Design CLARITY was a pragmatic, adaptive, multicentre, phase 3, randomised controlled trial. setting 17 hospital sites in India and Australia. ParticiPants Participants were at least 18 years old, previously untreated with angiotensin receptor blockers, with a laboratory confirmed diagnosis of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection who had been admitted to hospital for management of covid-19. interventiOn Oral angiotensin receptor blockers (telmisartan in India) or placebo (1:1) for 28 days. Main OutcOMe Measures The primary endpoint was covid-19 disease severity using a modified World Health Organization Clinical Progression Scale (WHO scale) at day 14. Secondary outcomes were WHO scale scores at day 28, mortality, intensive care unit admission, and respiratory failure. Analyses were evaluated on an ordinal scale in the intention-to-treat population. results Between 3 May 2020 and 13 November 2021, 2930 people were screened for eligibility, with 393 randomly assigned to angiotensin receptor blockers (of which 388 (98.7%) to telmisartan 40 mg/day) and 394 to the control group. 787 participants were randomised: 778 (98.9%) from India and nine (1.1%) from Australia. The median WHO scale score at day 14 was 1 (interquartile range 1-1) in 384 participants assigned angiotensin receptor blockers and 1 (1-1) in 382 participants assigned placebo (adjusted odds ratio 1.51 (95% credible interval 1.02 to 2.23), probability of an odds ratio of >1 (Pr(OR>1)=0.98). WHO scale scores at day 28 showed little evidence of difference between groups (1.02 (0.55 to 1.87), Pr(OR>1)=0.53). The trial was stopped when a prespecified futility rule was met. cOnclusiOns In patients admitted to hospital for covid-19, mostly with mild disease, not requiring oxygen, no evidence of benefit, based on disease severity score, was found for treatment with angiotensin receptor blockers, using predominantly 40 mg/day of telmisartan. trial registratiOn ClinicalTrials.gov NCT04394117.
Scientific Reports, 2021
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 ...
Canadian Journal of Cardiology, 2020
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2020
Effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in the treatment of COVID-19 is highly debated. It 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 increased risk of mortality as compared to those not taking ACEIs/ARBs (RR 0.89; 95% CI 0.64-1.23; P=0.48). Further, the risk of composite severe clinical manifestations was not found significantly different b...
Association of Angiotensin Receptor Blockers With the Risk of COVID-19 in Korea
CardioMetabolic Syndrome Journal, 2022
Background and Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses the angiotensin-converting enzyme (ACE) 2 receptor for host cell entry. Angiotensin receptor blockers (ARBs) may increase ACE2 activity. This study investigated the impact of ARBs use on the risk and severity of coronavirus disease 2019 (COVID-19). Methods: This study used data from a nationwide COVID-19 cohort, including all subjects who underwent a SARS-CoV-2 test in Korea. The COVID-19 group included 7,723 patients with positive SARS-CoV-2 test results, and the matched control group included 46,231 subjects with negative results. The study outcomes were SARS-CoV-2 positivity and severe COVID-19. Results: The prevalence of hypertension was lower in the COVID-19 group compared with the control group (24.8% vs. 30.3%, respectively, p<0.001). The prevalence of ARBs use was similar between both groups (p=0.426). ARBs were not associated with a higher risk of COVID-19 (adjusted odds ratio [aOR], 0.97; 95% confidence interval [CI], 0.89-1.05; p=0.426) or a higher risk of severe COVID-19 (aOR, 1.17; 95% CI, 0.90-1.50; p=0.238). Any types of ARBs were not associated with a higher risk of COVID-19 Conclusions: In this nationwide COVID-19 cohort, none of the different types of ARBs were associated with an increased risk of COVID-19 or severe COVID-19. Antihypertensive medications, including ARBs, should be continued in hypertensive patients amid the COVID-19 pandemic.