Current best evidence for clinical care (more info)
An association among the use of angiotensin converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) with the clinical outcomes of coronavirus disease 2019 (COVID-19) is unclear. PubMed, EMBASE, MedRxiv, and BioRxiv were searched for relevant studies that assessed the association between application of ACEI/ARB and risk of COVID-19, inflammation level, severity COVID-19 infection, and death in patients with COVID-19. Eleven studies were included with 33 483 patients. ACEI/ARB therapy might be associated with the reduced inflammatory factor (interleukin-6) and elevated immune cells counts (CD3, CD8). Meta-analysis showed no significant increase in the risk of COVID-19 infection (odds ratio [OR]: 0.95, 95%CI: 0.89-1.05) in patients receiving ACEI/ARB therapy, and ACEI/ARB therapy was associated with a decreased risk of severe COVID-19 (OR: 0.75, 95%CI: 0.59-0.96) and mortality (OR: 0.52, 95%CI: 0.35-0.79). Subgroup analyses showed among the general population, ACEI/ARB therapy was associated with reduced severe COVID-19 infection (OR: 0.79, 95%CI: 0.60-1.05) and all-cause mortality (OR: 0.31, 95%CI: 0.13-0.75), and COVID-19 infection (OR: 0.85, 95% CI: 0.66-1.08) were not increased. Among patients with hypertension, the use of an ACEI/ARB was associated with a lower severity of COVID-19 (OR: 0.73, 95%CI: 0.51-1.03) and lower mortality (OR: 0.57, 95%CI: 0.37-0.87), without evidence of an increased risk of COVID-19 infection (OR: 1.00). On the basis of the available evidence, ACEI/ARB therapy should be continued in patients who are at risk for, or have COVID-19, either in general population or hypertension patients. Our results need to be interpreted with caution considering the potential for residual confounders, and more well-designed studies that control the clinical confounders are necessary to confirm our findings.
| Discipline / Specialty Area | Score |
|---|---|
| Infectious Disease | |
| Intensivist/Critical Care | |
| Hospital Doctor/Hospitalists | |
| Internal Medicine | |
| Respirology/Pulmonology | |
This meta-analysis looked at data from over 30,000 patients and concluded that, if anything, users of ACEI and ARB drugs may have reduced severity of COVID-19 infection. It reviewed data available as of April 30, and there is likely to be quite a bit more by now.
This is already known. Nothing new!
This is pretty old news by now.
This has been published about more and more and is now well recognized, so not sure this is newsworthy.
I think this is so potentially confounded (e.g., if you're taking ARB you presumably have good healthcare access). It's difficult to make leaps.
This meta-analysis of mostly observational studies suggests that ACEI/ARB use does not increase risk for worsening Covid-19 infection. The review also suggests possibility of benefit, especially in hypertensive patients. A more rigorous review has been published (Ann Intern Med 2020;173:195).
Well done analysis of current studies addressing the risks/benefits of continuing ACE inh/ARBs in the era of the Covid pandemic. It addresses the limitations of the study and should assure physicians that there is no need to stop these medications. It suggests there could be a benefit to patients currently receiving this therapy.