Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults

This review (14 observational studies, n=23,565) found a consistent lack of association between ACEI or ARB use and illness severity, and moderate-certainty evidence suggesting no association between their use and positive SARS-CoV-2 test results among symptomatic patients.

SPS commentary:

This is a living systematic review with ongoing literature surveillance and critical appraisal. The second update of this review (published 23rd July) identified 3 new meta-analyses, 5 new observational studies, and 1 in-progress trial for inclusion. The results of the meta-analyses and 4 of the observational studies are consistent with previously reported findings. Although one retrospective study of 113 patients hospitalised with COVID-19 in Turkey found use of ACEI/ARBs to be associated with higher in-hospital mortality, those taking ACEI/ARBs were older and more likely to have coronary artery disease than the non–ACEI/ARB group. An ongoing RCT comparing valsartan with placebo on ICU admission, mechanical ventilation, and death among hospitalised adults with COVID-19 is due to complete in December 2021.


Annals of Internal Medicine

Resource links:

Second update