Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers and Outcomes in patients with COVID-19: A Systematic Review and Meta-Analysis.

Lo, Kevin Bryan; Bhargav, Ruchika; Salacup, Grace; Pelayo, Jerald; Albano, Jeri; McCullough, Peter A; Rangaswami, Janani

BACKGROUND There remains controversy over the usage of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) in patients with coronavirus disease 2019 (COVID-19) given their interaction with the angiotensin converting enzyme-2 (ACE-2) receptor mechanism. OBJECTIVE To investigate the impact of ACEI/ARB on COVID-19 associated disease severity and mortality through a systematic review and meta-analysis of existing literature. METHODS We searched PubMed and CINAHL databases as well as pre-print servers for gray literature regarding studies investigating usage of ACEIs/ARBs in patients with confirmed COVID-19 compared to a control group of COVID-19 patients without ACEI/ARB use. COVID-19 related severity of disease, and death were identified as end points. Pooled odds ratios (OR) and their 95% confidence intervals (CI) were calculated using random-effects model. RESULTS 21 studies were included in the meta-analysis. For mortality with ACEI/ARB use, the pooled odds ratio was 1.29 [0.89-1.87] p=0.18 with heterogeneity of 91%, while the pooled OR for COVID-19 severity was 0.94 [0.59-1.50] p=0.81 with heterogeneity of 89% (Figure2). In combining both mortality and severe disease outcomes, the pooled odds ratio was 1.09 [0.80-1.48] p=0.58 but with heterogeneity of 92%. [Figure: see text]. CONCLUSION use of ACEI/ARB was not associated with increased mortality or severe COVID-19.