The use of renin–angiotensin–aldosterone system (RAAS) inhibitors is associated with a lower risk of mortality in hypertensive COVID‐19 patients: A systematic review and meta‐analysis

Wang, Yixuan; Chen, Baixin; Li, Yun; Zhang, Lei; Wang, Yuyi; Yang, Shuaibing; Xiao, Xue; Qin, Qingsong

doi:10.1002/jmv.26625

Cited by 64 publications

(71 citation statements)

References 42 publications

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“…This hypothesis was supported by initial findings that these medications were more frequently used in COVID-19 patients with cardiac injury or in those with severe form of disease ( 8 , 9 ). Nevertheless, later reports failed to show any negative relationship between adverse outcome and use of ACEI and ARB in COVID-19 patients ( 10 – 13 ).…”

Section: Antihypertensive Therapy In Covid-19mentioning

confidence: 97%

“…There was a long discussion regarding the impact of antihypertensive therapy in COVID-19 patients and particularly of angiotensin-converting enzyme inhibitors (ACEI) and blockers of angiotensin I receptors (ARB). After initial reports that showed higher prevalence of use of these medications in COVID-19 patients with cardiac injury and more severe course of disease ( 8 , 9 ), numerous original studies and meta-analysis reported no relationship with severity or mortality in COVID-19 patients ( 10 , 11 ) or even benefit of taking renin-angiotensin-aldosterone inhibitors in COVID-19 patients ( 12 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

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Hypertension and COVID-19: Ongoing Controversies

Tadić

Saeed

Grassı

et al. 2021

Front. Cardiovasc. Med.

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Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic responsible for millions of deaths around the world. Hypertension has been identified as one of the most common comorbidities and risk factors for severity and adverse outcome in these patients. Recent investigations have raised the question whether hypertension represents a predictor of outcome in COVID-19 patients independently of other common comorbidities such as diabetes, obesity, other cardiovascular diseases, chronic kidney, liver, and pulmonary diseases. However, the impact of chronic and newly diagnosed hypertension in COVID-19 patients has been insufficiently investigated. The same is true for the relationship between blood pressure levels and outcomes in COVID-19 patients. It seems that the long discussion about the impact of angiotensin-converting enzyme inhibitors (ACEI) and blockers of angiotensin I receptors (ARB) on severity and outcome in COVID-19 is approaching an end because the large number of original studies and meta-analyses discarded the initial findings about higher prevalence of ACEI/ARB use in patients with unfavorable outcomes. Nevertheless, there are many controversies in the relationship between hypertension and COVID-19. The aim of this review article is to provide a clinical overview of the currently available evidence regarding the predictive value of hypertension, the effect of blood pressure levels, the impact of previously known and newly diagnosed hypertension, and the effect of antihypertensive therapy on the severity and outcomes in COVID-19 patients.

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Section: Antihypertensive Therapy In Covid-19mentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Hypertension and COVID-19: Ongoing Controversies

Tadić

Saeed

Grassı

et al. 2021

Front. Cardiovasc. Med.

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“…Meta-analysis of studies of ACEI/ ARB usage among COVID-19 patients showed no significant increase in the risk of COVID-19 infection, but did show a decreased risk of severe COVID-19 and mortality in patients receiving ACEI/ARB therapy [8][9][10]. Furthermore, a meta-analysis of twenty-six studies involving 8,104 hypertensive ACEI/ARB users and 8,203 hypertensive non-ACEI/ARB users reported a significantly lower risk of mortality and a lower need for ventilator use among ACEI/ARB users [11]. We thus sought to investigate two classes of anti-hypertension medications, ACEI and ARB, for their different associations with COVID-19 occurrence and severity by using a large cohort of Veterans in the Department of Veterans Affairs (VA) COVID-19 Shared Data Resource.…”

Section: Introductionmentioning

confidence: 94%

The association of COVID-19 occurrence and severity with the use of angiotensin converting enzyme inhibitors or angiotensin-II receptor blockers in patients with hypertension

Wang

Ndiwane³

et al. 2021

PLoS ONE

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Background A number of studies have reported the association between the use of angiotensin-converting enzyme inhibitor (ACEI) and angiotensin-II receptor blocker (ARB) medications and the occurrence or severity of coronavirus disease 2019 (COVID-19). Published results are inconclusive, possibly due to differences in participant comorbidities and sociodemographic backgrounds. Since ACEI and ARB are frequently used anti-hypertension medications, we aim to determine whether the use of ACEI and ARB is associated with the occurrence and severity of COVID-19 in a large study of US Veterans with hypertension. Methods Data were collected from the Department of Veterans Affairs (VA) National Corporate Data Warehouse (VA-COVID-19 Shared Data Resource) between February 28, 2020 and August 18, 2020. Using data from 228,722 Veterans with a history of hypertension who received COVID-19 testing at the VA, we investigated whether the use of ACEI or ARB over the two years prior to the index date was associated with increased odds of (1) a positive COVID-19 test, and (2) a severe outcome (hospitalization, mortality, and use of intensive care unit (ICU) and/or mechanical ventilation) among COVID-19-positive patients. We used logistic regression with and without propensity score weighting (PSW) to estimate the odds ratio (OR) and 95% confidence interval (95% CI) for the association between ACEI/ARB use and a positive COVID-19 test result. The association between medication use and COVID-19 outcome severity was examined using multinomial logistic regression comparing participants who were not hospitalized to participants who were hospitalized, were admitted to the ICU, used a mechanical ventilator, or died. All models were adjusted for relevant covariates, including demographics (age, sex, race, ethnicity), selected comorbidities, and the Charlson Comorbidity Index (CCI). Results The use of ACEI significantly decreased the odds of a positive COVID-19 test among Veterans with hypertension (OR = 0.917, (0.887, 0.948) and OR = 0.926, (0.894, 0.958) with PSW). The use of ACEI, but not of ARB, was also associated with significantly increased odds of using mechanical ventilators (OR = 1.265, (1.010, 1.584) and OR = 1.210, (1.053, 1.39) with PSW) among all COVID-19 inpatients compared to outpatients. Conclusions In this study of Veterans with hypertension, ACEI was significantly associated with decreased odds of testing positive for COVID-19. With the exception of the association of ACEI with a small non-clinically-important increase in the odds of using mechanical ventilators, neither ACEI nor ARB was found to be associated with clinical severity or mortality among COVID-19-positive Veterans. The results of this study need further corroboration and validation in other cohort samples outside the VA.

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“…Several recently published studies have confirmed that ACEIs/ARBs are not associated with increased mortality in hypertensive patients with COVID-19 and should not be discontinued [41][42][43][44]. A systematic review and meta-analysis by Wang et al (2021) supported this observation and added that the use of ACEIs/ARBs is associated with a lower risk of ventilator support [45].…”

Section: Discussionmentioning

confidence: 97%

Is treated hypertension associated with a lower one-year mortality among older residents of long-term care facilities with multimorbidity?

Kańtoch

Pac

Wizner

et al. 2021

Polish Archives of Internal Medicine

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This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA 4.0), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited, distributed under the same license, and used for noncommercial purposes only.

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The use of renin–angiotensin–aldosterone system (RAAS) inhibitors is associated with a lower risk of mortality in hypertensive COVID‐19 patients: A systematic review and meta‐analysis

Cited by 64 publications

References 42 publications

Hypertension and COVID-19: Ongoing Controversies

Hypertension and COVID-19: Ongoing Controversies

The association of COVID-19 occurrence and severity with the use of angiotensin converting enzyme inhibitors or angiotensin-II receptor blockers in patients with hypertension

Is treated hypertension associated with a lower one-year mortality among older residents of long-term care facilities with multimorbidity?

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