Lack of association of antihypertensive drugs with the risk and severity of COVID-19: A meta-analysis

J Cardiol. 2021 May;77(5):482-491. doi: 10.1016/j.jjcc.2020.10.015. Epub 2020 Nov 2.

Abstract

Background: The association of antihypertensive drugs with the risk and severity of COVID-19 remains unknown.

Methods and results: We systematically searched PubMed, MEDLINE, The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and medRxiv for publications before July 13, 2020. Cohort studies and case-control studies that contain information on the association of antihypertensive agents including angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), calcium-channel blockers (CCBs), β-blockers, and diuretics with the risk and severity of COVID-19 were selected. The random or fixed-effects models were used to pool the odds ratio (OR) with 95% confidence interval (CI) for the outcomes. The literature search yielded 53 studies that satisfied our inclusion criteria, which comprised 39 cohort studies and 14 case-control studies. These studies included a total of 2,100,587 participants. We observed no association between prior usage of antihypertensive medications including ACEIs/ARBs, CCBs, β-blockers, or diuretics and the risk and severity of COVID-19. Additionally, when only hypertensive patients were included, the severity and mortality were lower with prior usage of ACEIs/ARBs (overall OR of 0.81, 95% CI 0.66-0.99, p < 0.05 and overall OR of 0.77, 95% CI 0.66-0.91, p < 0.01).

Conclusions: Taken together, usage of antihypertensive drugs is not associated with the risk and severity of COVID-19. Based on the current available literature, it is not recommended to abstain from the usage of these drugs in COVID-19 patients.

Registration: The meta-analysis was registered on OSF (https://osf.io/ynd5g).

Keywords: Antihypertensive drugs; COVID-19; Meta-analysis; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2.

Publication types

  • Meta-Analysis
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Angiotensin Receptor Antagonists / therapeutic use*
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Antihypertensive Agents / adverse effects*
  • Antihypertensive Agents / therapeutic use*
  • COVID-19 / epidemiology*
  • COVID-19 / prevention & control
  • COVID-19 Drug Treatment*
  • Calcium Channel Blockers / therapeutic use
  • Case-Control Studies
  • Diuretics / therapeutic use
  • Humans
  • Hypertension / complications
  • SARS-CoV-2

Substances

  • Adrenergic beta-Antagonists
  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Calcium Channel Blockers
  • Diuretics