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?:abstract
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INTRODUCTION There are concerns that angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) may worsen outcomes in patients with coronavirus disease 2019 (COVID-19). This systemic review and meta-analysis aimed to study in-hospital mortality in COVID-19 patients who were on ACEI/ARB as compared to those not on ACEI/ARB. METHODS We search PubMed, EMBASE, clinicaltrials.gov and Google Scholar between 1 January 2020 and 30 May 2020 to identify all studies that evaluated the use of ACEI/ARB and reported the in-hospital mortality outcomes in COVID-19 patients. Nine non-randomised studies were eligible for inclusion in the analysis. The primary outcome studied was in-hospital mortality of COVID-19 patients who were on ACEI/ARB compared with those not on ACEI/ARB. RESULTS Of the 8,313 patients in the nine studies, 7,622 (91.7%) were from studies with all-comers, while 691 (8.3%) were from studies with only hypertensive patients. 577 (14.6%) in-hospital deaths were observed out of a total of 3,949 patients with an outcome in the nine studies. Overall, there was no significant difference in in-hospital mortality between patients on ACEI/ARB and those not on ACEI/ARB (odds radio [OR] 1.06, 95% confidence interval [CI] 0.75-1.50; p = 0.73). Further sensitivity analysis in the hypertensive group and all-comers group showed similar results (OR 0.88, 95% CI 0.58-1.32; p = 0.53 and OR 1.85, 95% CI 1.00-3.43; p = 0.05, respectively). CONCLUSION This study found that ACEI/ARB has no significant impact on in-hospital mortality in COVID-19 patients and can be used safely in patients with indications.
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