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Meta-analyses: ACEI/ARB and COVID-19

Presented by
Dr Yujiro Yokoyama, St. Luke's University Hospital
AHA 2020

Two new meta-analyses confirm that the use of angiotensin-converting-enzyme inhibitors (ACEI) and/or angiotensin-receptor blockers (ARB) is not associated with a higher susceptibility of COVID-19, nor with an increased mortality risk in COVID-19 patients [1].

COVID‐19 can infect host cells through interaction with membrane‐bound ACE2 on respiratory epithelium. Theoretically, the use of ACEI and ARB may modify susceptibility to COVID-19-infection since these drugs both increase the expression of ACE. The results of 2 new meta-analyses among ACEI and/or ARB users were presented, investigating the rate of testing positive for COVID-19 and the in-hospital mortality rate for patients with COVID-19, respectively.

The first analysis included 3 studies and demonstrated that the rates of positive testing were similar for ACEI users and non-users: OR 0.96 (95% CI 0.88–1.04; P=0.69), as well as for ARB users and non-users: OR 0.99 (95% CI 0.91–1.08; P=0.35).

The second analysis included 14 studies. The results demonstrated that in-hospital mortality for patients with COVID-19 was similar between ACEI and/or ARB users and non-users: HR 0.88 (95% CI 0.64–1.20; P=0.42). A subanalysis of studies confined to patients with hypertension showed that ACEI and/or ARB use was associated with a significantly lower in-hospital mortality: HR 0.65 (95% CI 0.48–0.87).

    1. Yokoyama Y, et al. Meta-analyses for the Effect of Renin-angiotensin-aldosterone System Inhibitors on Mortality and Testing Positive of Covid-19. Abstract 399, AHA Scientific Sessions 2020, 13–17 Nov.


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