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?:abstract
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OBJECTIVE: The association between the use of renin-angiotensin-aldosterone (RAAS) inhibitors and the risk of mortality from COVID-19 is unclear We aimed to estimate the association of RAAS inhibitors, including ACE inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) with COVID-19 mortality risk in patients with hypertension METHODS: PubMed (MEDLINE) SCOPUS, OVID, Cochrane Library databases and medrxiv org were searched from 1 January 2020 to 1 September 2020 Studies reporting the association of RAAS inhibitors (ACEi or ARBs) and mortality in patients with hypertension, hospitalised for COVID-19 were extracted Two reviewers independently extracted appropriate data of interest and assessed the risk of bias All analyses were performed using random-effects models on log-transformed risk ratio (RR) estimates, and heterogeneity was quantified RESULTS: Fourteen studies were included in the systematic review (n=73,073 patients with COVID-19;mean age 61 years;53% male) Overall, the between-study heterogeneity was high (I(2)=80%, p<0 01) Patients with hypertension with prior use of RAAS inhibitors were 35% less likely to die from COVID-19 compared with patients with hypertension not taking RAAS inhibitors (pooled RR 0 65, 95% CI 0 45 to 0 94) The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations was graded as \'moderate\' quality CONCLUSIONS: In this meta-analysis, with prior use of RAAS inhibitors was associated with lower risk mortality from COVID-19 in patients with hypertension Our findings suggest a potential protective effect of RAAS-inhibitors in COVID-19 patients with hypertension PROSPERO REGISTRATION NUMBER: The present study has been registered with PROSPERO (registration ID: CRD 42020187963)
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