The effect of angiotensin converting enzyme inhibitors and angiotensin
receptor blockers on death and severity of disease in patients with
coronavirus disease 2019 (COVID-19): A meta-analysis
Abstract
Aims and Methods: Effect of angiotensin converting enzyme inhibitors
(ACEi) and angiotensin receptor blockers (ARB) on outcomes in patients
with coronavirus disease 2019 (COVID-19) is uncertain. Available
evidence is limited to a few retrospective observational studies with
small number of patients. We did a meta-analysis to assess the effect of
ACEi/ARB in patients with COVID-19 on severity of disease, risk for
hospitalisation, and death compared to those not on ACEi/ARB. We
searched the Cochrane library, PubMed, Embase, ClinicalTrial.gov and
medRxiv for studies published until 25.04.2020. Inclusion criteria
included all studies with patients with confirmed COVID-19 either
taking, or not taking, ACEi/ARB. Depending on degree of heterogeneity,
fixed or random effect model was selected to calculate effect size (Odds
ratio). Results: Six studies were eligible for this meta-analysis. These
included 423 patients on ACEi/ARB, and 1419 not on ACEi/ARB. Compared to
patients with COVID-19 not on ACEi/ARB, there was a statistically
significant 43% reduction (OR 0.57, CI: 0.37-0.88, I2: 0.000) in the
odds of death in those on ACEi/ARB. There was a statistically
non-significant 38% reduction (OR: 0.62, 95% CI: 0.31-1.23, I2=70.36)
in the odds of developing severe disease and 19% reduction (OR 0.81;
95% CI: 0.42-1.55, I2: 0.000) in the odds of hospitalisation among
those on ACEi/ARB. Discussion: It is safe to use ACEi/ARB in patients
with COVID-19 requiring these medications for associated comorbidities.
Although limited by confounding factors typical of a meta-analysis of
retrospective observational studies, our data suggests that use of these
medications may reduce the odds of death. Conclusion: Our meta-analysis
of the updated studies on SARS-CoV-2 reassures the medical fraternity on
the use of and continuation of ACEi/ARB, supporting all recent
recommendations .