The use of renin angiotensin system inhibitor on mortality in patients with coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis
Data
2020Autor
Pranata, Raymond
Permana, Hikmat
Huang, Ian
Lim, Michael Anthonius
Soetedjo, Nanny Natalia M.
Supriyadi, Rudi
Yuwono Soeroto, Arto
Aziz Alkatiri, Amir
Firman, Doni
Lukito, Antonia Anna
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Resumo
Background: and Aims; To investigate the association between use of angiotensin-converting enzyme
inhibitor (ACEI)/angiotensin-receptor blocker (ARB) and outcomes of hypertensive COVID-19 patients, a
systematic review and meta-analysis were performed.
Methods: We systematically searched PubMed, EuropePMC, ProQuest, and Cochrane Central Databases
using the terms “(COVID-19 OR SARS-CoV-2) AND (angiotensin converting enzyme OR angiotensin receptor blocker)”. The primary and second outcomes were mortality (non-survivor) and severe COVID-19,
respectively.
Results: Totally, 7410 patients were included from 15 studies. Pooled analysis showed that the use of
ACEI/ARB was not associated with mortality (OR 0.73 [0.38, 1.40], p ¼ 0.34; I2
: 81%) and severity (OR 1.03
[0.73, 1.45], p ¼ 0.87; I2
: 65%). Pooled adjusted OR showed no risk/benefit associated with ACEI/ARB use
in terms of mortality (OR 0.83 [0.54, 1.27], p ¼ 0.38; I2
: 0%). Subgroup analysis showed that the use of ARB
was associated with reduced mortality (OR 0.51 [0.29, 0.90], p ¼ 0.02; I2
: 22%) but not ACEI subgroup (OR
0.68 [0.39, 1.17], p ¼ 0.16; I2
: 0%). Meta-regression showed that the association between ACEI/ARB use
and mortality in patients with COVID-19 do not varies by gender (p ¼ 0.104). GRADE showed a very low
certainty of evidence for effect of ACEI/ARB on mortality and severity. The certainty of evidence was very
low for both ACEI and ARB subgroups.
Conclusion: Administration of a renin angiotensin system (RAS) inhibitor, was not associated with
increased mortality or severity of COVID-19 in patients with hypertension. Specifically, ARB and not ACEI
use, was associated with lower mortality.
Palabras clave
Angiotensin converting enzyme inhibitor; Angiotensin receptor blocker; Coronavirus; COVID-19; HypertensionLink para o recurso
https://doi.org/10.1016/j.dsx.2020.06.047Collections
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