Effect of Renin-Angiotensin-Aldosterone System inhibitors on outcomes of COVID-19 patients with hypertension: Systematic review and Meta-analysis

Beressa, Tamirat Bekele; Sahilu, Tamiru; Deyno, Serawit

doi:10.1101/2020.09.03.20187393

Cited by 3 publications

(21 citation statements)

References 39 publications

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“…Eight (66.7%) out of 12 systematic reviews found no association between the use of ACEI or ARBs and COVID-19 outcomes ( Table 6 and S6 Table) such as susceptibility to infection, hospitalization, severity and mortality, while some studies found no association even after adjusting for potential confounding factors [ 67 68 69 70 71 72 73 74 ]. However, in one study the use of RAASI was found to decrease the length of hospital stay [ 67 ].…”

Section: Resultsmentioning

confidence: 99%

Cardiac Manifestations in Patients with COVID-19: A Scoping Review

et al. 2022

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Background: Coronavirus disease 2019 , commonly affects the lungs, but the involvement of other organs, particularly the heart, is highly prevalent as has been reported in several studies. The overall aim of this review was to provide an in-depth description of the available literature related to the cardiac system and COVID-19 infection. It focuses on type and the frequency of cardiac manifestations, clinical parameters and cardiac biomarkers that support the prognosis of COVID-19 patients, and the cardiac adverse events and outcomes related to pharmacotherapy.Methods: A scoping review was conducted searching Embase, PubMed, Epistomonikos, Medrxiv, BioRxiv databases, up to November 2020, for systematic reviews relevant to cardiac manifestations in adult COVID-19 patients. Relevant articles were screened and extracted to summarize key outcomes and findings.Results: A total of 63 systematic reviews met the inclusion criteria. The overall frequency of acute cardiac injury ranged from 15% to 33% in the reporting studies. The main cardiac complications were arrhythmias (3.1% to 6.9% in non-severe patients, 33.0% to 48.0% in severe disease), acute coronary syndromes (6% to 33% in severe disease), and myocarditis. Most studies found no association with the use of Reninangiotensin-aldosterone system inhibitors (RAASI) with COVID-19 outcomes such as susceptibility to infection, hospitalization, severity, and mortality. Conclusion:This study provided an overview of the several cardiac complications associated with Covid-19. Cardiac injury, arrhythmias, myocarditis, cardiac failure, and acute coronary syndrome, are prevalent and clinically significant and associated with COVID-19 disease severity and mortality. Other studies are needed to clearly identify what is the part of viral heart infection and what is the part of cardiac injury secondary to acute respiratory failure and inflammation. In the therapeutic field, these systematic reviews gave heterogenous results. This underlines the importance of randomized trials to determine the right therapeutic approach. 2 Peiris et al.

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Section: Resultsmentioning

confidence: 99%

Cardiac Manifestations in Patients with COVID-19: A Scoping Review

et al. 2022

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“…In terms of number of COVID-19 related outcomes reported in each review, one outcome was reported by 13 reviews (27.7%) (18, 20, 21, 23, 24, 28, 29, 38, 39, 47, 52, 53, 61), two outcomes by 15 reviews (31.9%) (4, 17, 26, 31, 32, 34-37, 40, 42, 49, 54, 55, 58), three outcomes by 11 reviews (23.4%) (6, 22, 25, 27, 33, 44-46, 50, 56, 60) and 4-9 outcomes by eight reviews (17%) (19, 30, 41, 43, 48, 51, 57, 59). Overall, the 47 eligible reviews reported data on 18 unique pooled outcome estimates including death in 36 reviews, reviews (4, 6, 17-19, 22, 24, 25, 27, 30-39, 41-49, 54-56, 58-60), ICU admission in nine reviews (27, 28, 30, 41, 43, 48, 51, 56, 59), death/ICU admission as a composite outcome in 16 reviews (4, 20, 21, 23, 26, 29, 31, 32, 40, 41, 43, 45, 51, 55, 59), risk of acquiring COVID-19 infection in 15 reviews (19, 25, 27, 40<...>…”

Section: Resultsmentioning

confidence: 99%

“…Considering the critical domains, most reviews were considered to have had a satisfactory technique for the statistical combination of results (n=45, 95.7%) (4-6, 17-22, 24-57, 59, 60) and for assessing risk of bias (n=38, 80.1%) (4-6, 17, 19-23, 25-28, 30, 31, 34-38, 40-46, 48-53, 55-57, 59, 60). Less reviews were favourably considered in terms of accounting for risk of bias when interpreting and discussing the results (n=32, 68.1%), with appropriate conduct of publication bias (n=33) (4-6, 17, 19-21, 23-27, 30-33, 37, 38, 41-45, 47, 49-51, 53, 56, 57, 59, 60), and only 15 (31.9%) reviews referred to the review methods being established a priori (19, 22, 25, 26, 28, 30, 34, 37, 41-43, 52, 55, 56, 59).…”

Section: Resultsmentioning

confidence: 99%

“…were published in a pre-print database) (17-19, 21-23, 30, 32-34, 36, 46, 50, 54, 60). The time the searches were conducted ranged from April 2020 to October 2020, with 21 (44.7%) review searches conducted in the month of May 2020 (4-6, 17, 21, 23, 24, 28, 30-32, 35, 36, 40-42, 44, 46, 48, 50, 54) Pre-print articles were included in 28 (59.6%) reviews (4, 17, 19-22, 25, 26, 30, 33, 37, 41-45, 47-53, 55, 56, 59, 60), and 10 (21.3%) reviews adjusted for retracted studies (4, 18, 31, 40, 45, 47-50, 56). Full details of the 47 reviews are presented in Supplementary file 3 .…”

Section: Resultsmentioning

confidence: 99%

“…Overall confidence in the results was ‘moderate’ for 10 (21.3%) reviews (19, 25, 26, 30, 37, 41-43, 56, 59), ‘low’ for 15 (30.6%) reviews (4, 5, 20-22, 27, 28, 31, 34, 45, 49-51, 55, 60), and ‘critically low’ for 22 (44.9%) reviews (6, 17, 18, 23, 24, 29, 32, 33, 35, 36, 38-40, 44, 46-48, 52-54, 57, 58) (Supplementary file 5 ). Considering the critical domains, most reviews were considered to have had a satisfactory technique for the statistical combination of results (n=45, 95.7%) (4-6, 17-22, 24-57, 59, 60) and for assessing risk of bias (n=38, 80.1%) (4-6, 17, 19-23, 25-28, 30, 31, 34-38, 40-46, 48-53, 55-57, 59, 60). Less reviews were favourably considered in terms of accounting for risk of bias when interpreting and discussing the results (n=32, 68.1%), with appropriate conduct of publication bias (n=33) (4-6, 17, 19-21, 23-27, 30-33, 37, 38, 41-45, 47, 49-51, 53, 56, 57...…”

Section: Resultsmentioning

confidence: 99%

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An umbrella review and meta-analysis of the use of renin-angiotensin system drugs and COVID-19 outcomes: what do we know so far?

Kurdi

Weir

Mueller

2022

Preprint

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BackgroundsEvidence from several meta-analyses are still controversial about the effects of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin-receptor blockers (ARBs) on COVID-19 outcomes.PurposeUmbrella review of systematic reviews/meta-analysis to provide comprehensive assessment of the effect of ACEIs/ARBs on COVID-19 related outcomes by summarising the currently available evidence.Data SourceMedline (OVID), Embase, Scopus, Cochrane library and medRxiv from inception to 1st February 2021.Study SelectionSystematic reviews with meta-analysis that evaluated the effect of ACEIs/ARBs on COVID-19 related clinical outcomesData ExtractionTwo reviewers independently extracted the data and assessed studies’ risk of bias using AMSTAR 2 Critical Appraisal Tool.Data SynthesisPooled estimates were combined using the random-effects meta-analyses model including several sub-group analyses. Overall, 47 reviews were eligible for inclusion. Out of the nine COVID-19 outcomes evaluated, there was significant associations between ACEIs/ARBs use and each of death (OR=0.80, 95%CI=0.75-0.86; I2=51.9%), death/ICU admission as composite outcome (OR=0.86, 95%CI=0.80-0.92; I2=43.9%), severe COVID-19 (OR=0.86, 95%CI=0.78-0.95; I2=68%), and hospitalisation (OR=1.23, 95%CI=1.04-1.46; I2= 76.4%). The significant reduction in death/ICU admission, however, was higher among studies which presented adjusted measure of effects (OR=0.63, 95%CI=0.47-0.84) and were of moderate quality (OR=0.74, 95%CI=0.63-0.85).LimitationsThe effect of unmeasured confounding could not be ruled out. Only 21.3% (n=10) of the studies were of ‘moderate’ quality.ConclusionCollective evidence from observational studies indicate a good quality evidence on the significant association between ACEIs/ARBs use and reduction in death and death/ICU admission, but poor-quality evidence on both reducing severe COVID-19 and increasing hospitalisation. Our findings further support the current recommendations of not discontinuing ACEIs/ARBs therapy in patients with COVID-19.RegistrationThe study protocol was registered in PROSPERO (CRD42021233398).Funding SourceNone

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An umbrella review and meta‐analysis of renin–angiotensin system drugs use and COVID‐19 outcomes

Kurdi

Mueller

Weir

2022

Eur J Clin Investigation

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Background: Despite the availability of extensive literature on the effect of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin-receptor blockers (ARBs) on COVID-19 outcomes, the evidence is still controversial. We aimed to provide a comprehensive assessment of the effect of ACEIs/ARBs on COVID-19-related outcomes by summarising the currently available evidence.Methods: An umbrella review was conducted using Medline (OVID), Embase, Scopus, Cochrane library and medRxiv from inception to 1 February 2021.Systematic reviews with meta-analysis that evaluated the effect of ACEIs/ARBs on COVID-19-related clinical outcomes were eligible. Studies' quality was appraised using the AMSTAR 2 Critical Appraisal Tool. Data were analysed using the random-effects modelling including several subgroup analyses. Heterogenicity was assessed using I 2 statistic. The study protocol was registered in PROSPERO (CRD42021233398) and reported using PRISMA guidelines.Results: Overall, 47 reviews were eligible for inclusion. Out of the nine COVID-19 outcomes evaluated, there was significant associations between ACEIs/ARBs use and each of death (OR = 0.80, 95%CI = 0.75-0.86; I 2 = 51.9%), death/ICU admission as composite outcome (OR = 0.86, 95%CI = 0.80-0.92; I 2 = 43.9%), severe COVID-19 (OR = 0.86, 95%CI = 0.78-0.95; I 2 = 68%) and hospitalisation (OR = 1.23, 95%CI = 1.04-1.46; I 2 = 76.4%). The significant reduction in death/ ICU admission, however, was higher among studies which presented adjusted measure of effects (OR = 0.63, 95%CI = 0.47-0.84) and were of moderate quality (OR = 0.74, 95%CI = 0.63-0.85). Conclusions:Collective evidence from observational studies indicate a good quality evidence on the significant association between ACEIs/ARBs use and reduction in death and death/ICU admission, but poor-quality evidence on both reducing severe COVID-19 and increasing hospitalisation. Our findings further support the current recommendations of not discontinuing ACEIs/ARBs therapy in patients with COVID-19.

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Effect of Renin-Angiotensin-Aldosterone System inhibitors on outcomes of COVID-19 patients with hypertension: Systematic review and Meta-analysis

Cited by 3 publications

References 39 publications

Cardiac Manifestations in Patients with COVID-19: A Scoping Review

Cardiac Manifestations in Patients with COVID-19: A Scoping Review

An umbrella review and meta-analysis of the use of renin-angiotensin system drugs and COVID-19 outcomes: what do we know so far?

An umbrella review and meta‐analysis of renin–angiotensin system drugs use and COVID‐19 outcomes

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