Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers and the risk of COVID-19 infection or severe disease: Systematic review and meta-analysis
Objective: Animal studies suggested that angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARB) facilitate the inoculation of potentially leading to a higher risk of infection and/or disease severity. We aimed to systematically evaluate the risk of COVID-19 infection...
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Format: | Article |
Language: | English |
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Elsevier
2020-12-01
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Series: | International Journal of Cardiology: Heart & Vasculature |
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Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906720303250 |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Daniel Caldeira Mariana Alves Ryan Gouveia e Melo Pedro Silvério António Nélson Cunha Afonso Nunes-Ferreira Luisa Prada João Costa Fausto J Pinto |
spellingShingle |
Daniel Caldeira Mariana Alves Ryan Gouveia e Melo Pedro Silvério António Nélson Cunha Afonso Nunes-Ferreira Luisa Prada João Costa Fausto J Pinto Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers and the risk of COVID-19 infection or severe disease: Systematic review and meta-analysis International Journal of Cardiology: Heart & Vasculature Coronavirus SARS-CoV-2 Angiotensin-converting enzyme inhibitor Angiotensin-receptor blocker Acute respiratory distress syndrome Acute lung injury |
author_facet |
Daniel Caldeira Mariana Alves Ryan Gouveia e Melo Pedro Silvério António Nélson Cunha Afonso Nunes-Ferreira Luisa Prada João Costa Fausto J Pinto |
author_sort |
Daniel Caldeira |
title |
Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers and the risk of COVID-19 infection or severe disease: Systematic review and meta-analysis |
title_short |
Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers and the risk of COVID-19 infection or severe disease: Systematic review and meta-analysis |
title_full |
Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers and the risk of COVID-19 infection or severe disease: Systematic review and meta-analysis |
title_fullStr |
Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers and the risk of COVID-19 infection or severe disease: Systematic review and meta-analysis |
title_full_unstemmed |
Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers and the risk of COVID-19 infection or severe disease: Systematic review and meta-analysis |
title_sort |
angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers and the risk of covid-19 infection or severe disease: systematic review and meta-analysis |
publisher |
Elsevier |
series |
International Journal of Cardiology: Heart & Vasculature |
issn |
2352-9067 |
publishDate |
2020-12-01 |
description |
Objective: Animal studies suggested that angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARB) facilitate the inoculation of potentially leading to a higher risk of infection and/or disease severity. We aimed to systematically evaluate the risk of COVID-19 infection and the risk of severe COVID-19 disease associated with previous exposure to (ACEi) and/or ARB). Methods: MEDLINE, CENTRAL, PsycINFO, Web of Science Core Collection were searched in June 2020 for controlled studies. Eligible studies were included and random-effects meta-analyses were performed. The estimates were expressed as odds ratios (OR) and 95% confidence intervals (95%CI). Heterogeneity was assessed with I2 test. The confidence in the pooled evidence was appraised using the GRADE framework. Results: Twenty-seven studies were included in the review. ACEi/ARB exposure did not increase the risk of having a positive test for COVID-19 infection (OR 0.99, 95%CI 0.89–1.11; I2 = 36%; 5 studies, GRADE confidence moderate). The exposure to ACEi/ARB did not increase the risk of all-cause mortality among patients with COVID-19 (OR 0.91, 95%CI 0.74–1.11; I2 = 20%; 17 studies; GRADE confidence low) nor severe/critical COVID-19 disease (OR 0.90, 95%CI 0.74–1.11; I2 = 55%; 17 studies; GRADE confidence very low). Exploratory analyses in studies enrolling hypertensive patients showed a association of ACEi/ARB with a significant decrease of mortality risk. Conclusions: ACEi/ARB exposure does not seem to increase the risk of having the SARS-CoV-2 infection or developing severe stages of the disease including mortality. The potential benefits observed in mortality of hypertensive patients reassure safety, but robust studies are required to increase the confidence in the results. |
topic |
Coronavirus SARS-CoV-2 Angiotensin-converting enzyme inhibitor Angiotensin-receptor blocker Acute respiratory distress syndrome Acute lung injury |
url |
http://www.sciencedirect.com/science/article/pii/S2352906720303250 |
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doaj-eb3d49cce76848419f081cb45f09a85f2020-12-19T05:08:54ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672020-12-0131100627Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers and the risk of COVID-19 infection or severe disease: Systematic review and meta-analysisDaniel Caldeira0Mariana Alves1Ryan Gouveia e Melo2Pedro Silvério António3Nélson Cunha4Afonso Nunes-Ferreira5Luisa Prada6João Costa7Fausto J Pinto8Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Univerisdade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; Cardiology Department, Hospital Universitário de Santa Maria (CHULN), Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; Corresponding author at: Centro Cardiovascular da Universidade de Lisboa - CCUL, Faculdade de Medicina, Universidade de Lisboa, Portugal. Av. Prof. Egas Moniz, Lisboa 1649-028, Portugal.Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; Serviço de Medicina III, Hospital Pulido Valente (CHULN), Lisboa, Portugal; Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisboa, PortugalCentro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Univerisdade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Avenida Professor Egas Moniz, 1649-028 Lisboa, PortugalCentro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Univerisdade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; Cardiology Department, Hospital Universitário de Santa Maria (CHULN), Avenida Professor Egas Moniz, 1649-028 Lisboa, PortugalCentro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Univerisdade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; Cardiology Department, Hospital Universitário de Santa Maria (CHULN), Avenida Professor Egas Moniz, 1649-028 Lisboa, PortugalCentro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Univerisdade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; Cardiology Department, Hospital Universitário de Santa Maria (CHULN), Avenida Professor Egas Moniz, 1649-028 Lisboa, PortugalLaboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, PortugalLaboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Lisboa, PortugalCentro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Univerisdade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal; Cardiology Department, Hospital Universitário de Santa Maria (CHULN), Avenida Professor Egas Moniz, 1649-028 Lisboa, PortugalObjective: Animal studies suggested that angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARB) facilitate the inoculation of potentially leading to a higher risk of infection and/or disease severity. We aimed to systematically evaluate the risk of COVID-19 infection and the risk of severe COVID-19 disease associated with previous exposure to (ACEi) and/or ARB). Methods: MEDLINE, CENTRAL, PsycINFO, Web of Science Core Collection were searched in June 2020 for controlled studies. Eligible studies were included and random-effects meta-analyses were performed. The estimates were expressed as odds ratios (OR) and 95% confidence intervals (95%CI). Heterogeneity was assessed with I2 test. The confidence in the pooled evidence was appraised using the GRADE framework. Results: Twenty-seven studies were included in the review. ACEi/ARB exposure did not increase the risk of having a positive test for COVID-19 infection (OR 0.99, 95%CI 0.89–1.11; I2 = 36%; 5 studies, GRADE confidence moderate). The exposure to ACEi/ARB did not increase the risk of all-cause mortality among patients with COVID-19 (OR 0.91, 95%CI 0.74–1.11; I2 = 20%; 17 studies; GRADE confidence low) nor severe/critical COVID-19 disease (OR 0.90, 95%CI 0.74–1.11; I2 = 55%; 17 studies; GRADE confidence very low). Exploratory analyses in studies enrolling hypertensive patients showed a association of ACEi/ARB with a significant decrease of mortality risk. Conclusions: ACEi/ARB exposure does not seem to increase the risk of having the SARS-CoV-2 infection or developing severe stages of the disease including mortality. The potential benefits observed in mortality of hypertensive patients reassure safety, but robust studies are required to increase the confidence in the results.http://www.sciencedirect.com/science/article/pii/S2352906720303250CoronavirusSARS-CoV-2Angiotensin-converting enzyme inhibitorAngiotensin-receptor blockerAcute respiratory distress syndromeAcute lung injury |