A systematic review and meta-analysis to evaluate the clinical outcomes in COVID-19 patients on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers

This review found no statistically significant difference between users of ACEI/ARB and non-users in either risk of developing severe disease (OR 0.81; 95% CI 0.41-1.58; p=0.53; pooled analysis of 4 studies) or risk of mortality (OR 0.86; 95% CI 0.53-1.41; p=0.55; 6 studies).

SPS commentary:

The authors note that there is limited data in this area and the study types are diverse; in addition there is a rapidly emerging knowledge base and the review may therefore not have captured all studies. Despite the overall pooled results suggesting no increased risk associated with use of ACEI/ARB, the results of individual studies were inconsistent. They conclude that based on current evidence, ACEI/ARB should be continued in patients with Covid-19, but that further investigation is needed on individual patient factors that may confer a higher risk of adverse outcomes (e.g. ACE2 polymorphisms).

European Heart Journal-Cardiovascular Pharmacotherapy