Renin-Angiotensin System Blockade and Mortality in Patients With Hypertension and COVID-19 Infection

J Cardiovasc Pharmacol Ther. 2020 Nov;25(6):503-507. doi: 10.1177/1074248420947628. Epub 2020 Aug 4.

Abstract

To determine the effect renin-angiotensin system blockers on the outcome in patients with hypertension and concurrent COVID-19 infection, we searched PubMed, the Cochrane Library, and Google Scholar for relevant articles. Twelve studies with a total of 16,101 patients met the inclusion criteria. The mortality rate among the users of angiotensin converting enzyme inhibitors or angiotensin receptor blockers was 12.15% and in non-users it was 14.56% (risk ratio 0.70, 95% CI [0.53-0.91], P < 0.007). There was no difference in the risk of death between the use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers (risk ratio 1.09, 95% CI [0.90 -1.32]). We conclude that the use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers improves mortality in patients with hypertension and concurrent COVID-19 infection, without a significant difference between ACEIs and ARBs in this population.

Keywords: COVID-19; hypertension; renin-angiotensin-aldosterone system.

Publication types

  • Review

MeSH terms

  • Angiotensin II Type 1 Receptor Blockers
  • Angiotensin Receptor Antagonists / therapeutic use*
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / mortality
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / epidemiology*
  • Pandemics
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / mortality
  • Renin-Angiotensin System / physiology
  • SARS-CoV-2

Substances

  • Angiotensin II Type 1 Receptor Blockers
  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors