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Respiratory infection
Original research
Renin-angiotensin system blocker and outcomes of COVID-19: a systematic review and meta-analysis
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  1. Hyun Woo Lee1,
  2. Chang-Hwan Yoon2,
  3. Eun Jin Jang3,
  4. Chang-Hoon Lee4
  1. 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Dongjak-gu, Seoul, The Republic of Korea
  2. 2 Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, The Republic of Korea
  3. 3 Department of Information Statistics, Andong National University, Andong, Gyeongsangbuk-do, The Republic of Korea
  4. 4 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Jongno-gu, Seoul, The Republic of Korea
  1. Correspondence to Dr Chang-Hoon Lee, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Jongno-gu 03080, Korea (the Republic of); kauri670{at}empal.com

Abstract

Background The association of ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) with disease severity of patients with COVID-19 is still unclear. We conducted a systematic review and meta-analysis to investigate if ACEI/ARB use is associated with the risk of mortality and severe disease in patients with COVID-19.

Methods We searched all available clinical studies that included patients with confirmed COVID-19 who could be classified into an ACEI/ARB group and a non-ACEI/ARB group up until 4 May 2020. A meta-analysis was performed, and primary outcomes were all-cause mortality and severe disease.

Results ACEI/ARB use did not increase the risk of all-cause mortality both in meta-analysis for 11 studies with 12 601 patients reporting ORs (OR=0.52 (95% CI=0.37 to 0.72), moderate certainty of evidence) and in 2 studies with 8577 patients presenting HRs. For 12 848 patients in 13 studies, ACEI/ARB use was not related to an increased risk of severe disease in COVID-19 (OR=0.68 (95% CI=0.44 to 1.07); I2=95%, low certainty of evidence).

Conclusions ACEI/ARB therapy was not associated with increased risk of all-cause mortality or severe manifestations in patients with COVID-19. ACEI/ARB therapy can be continued without concern of drug-related worsening in patients with COVID-19.

  • viral infection

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. The data are available by accessing the published studies listed in table 1.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/thoraxjnl-2020-215322

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. The data are available by accessing the published studies listed in table 1.

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    Supplementary materials

    Footnotes

    • Contributors Study concept and design: HWL and C-HL. Acquisition of data: HWL and C-HL. Analysis and interpretation of data: HWL and C-HL. Manuscript drafting: HWL and C-HL. Critical revision of the manuscript and important intellectual content: EJJ and C-HY. Study supervision: C-HL.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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