SynthesisEuropean heart journal. Cardiovascular pharmacotherapy2021
A systematic review and meta-analysis to evaluate the clinical outcomes in COVID-19 patients on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.
Synthesis in European heart journal. Cardiovascular pharmacotherapy, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers, 10 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
52 citing papers in PubMed, 10 syntheses or guidelines pooled it, 95 citations in OpenAlex.
- Discontinuation of Antihypertensive Drug Use Compared to Continuation in COVID-19 Patients: A Systematic Review with Meta-analysis and Trial Sequential Analysis.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2023Pooled it
- An umbrella review and meta-analysis of renin-angiotensin system drugs use and COVID-19 outcomes.European journal of clinical investigation · 2023Pooled it
- Effect of continuing the use of renin-angiotensin system inhibitors on mortality in patients hospitalized for coronavirus disease 2019: a systematic review, meta-analysis, and meta-regression analysis.BMC infectious diseases · 2023Pooled it
- Renin-Angiotensin Aldosterone System Inhibitors and COVID-19: A Systematic Review and Meta-Analysis Revealing Critical Bias Across a Body of Observational Research.Journal of the American Heart Association · 2022Pooled it
- Meta-analysis of the association between angiotensin pathway inhibitors and COVID-19 severity and mortality.Systematic reviews · 2021Pooled it
- Safety and Efficacy of Renin-Angiotensin-Aldosterone System Inhibitors in COVID-19 Population.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2021Pooled it
- Lack of association of antihypertensive drugs with the risk and severity of COVID-19: A meta-analysis.Journal of cardiology · 2021Pooled it
- Association of renin-angiotensin-aldosterone system inhibitors with mortality and testing positive of COVID-19: Meta-analysis.Journal of medical virology · 2021Pooled it
- A systematic review and meta-analysis of the use of renin-angiotensin system drugs and COVID-19 clinical outcomes: What is the evidence so far?Pharmacology research & perspectives · 2020Pooled it
- Mortality and Disease Severity Among COVID-19 Patients Receiving Renin-Angiotensin System Inhibitors: A Systematic Review and Meta-analysis.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2020Pooled it
- Neurological, psychological, psychosocial complications of long-COVID and their management.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Review
- Use of chronic medications and risk of death due to COVID-19 in hospitalised patients.European journal of hospital pharmacy : science and practice · 2024Article
- Review
- Timing matters in the use of renin-angiotensin system modulators and COVID-related cognitive and cerebrovascular dysfunction.PloS one · 2024Article
- Long-term oral ACEI/ARB therapy is associated with disease severity in elderly COVID-19 omicron BA.2 patients with hypertension.BMC infectious diseases · 2023Article
- Role of Angiotensin Converting Enzyme-2 and its modulation in disease: exploring new frontiers.Medicine and pharmacy reports · 2023Review
- Potential use of renin-angiotensin-aldosterone system inhibitors to reduce COVID-19 severity.Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology · 2023Review
- Mortality from angiotensin-converting enzyme-inhibitors and angiotensin receptor blockers in people infected with COVID-19: a cohort study of 3.7 million people.Family practice · 2023Article
- Increasing digitalization is associated with anxiety and depression: A Google Ngram analysis.PloS one · 2023Article
- Article
Corrections and comments
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Authors and funding
2 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionAngiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) share their target receptor site with the SARS-CoV-2 virus, that may cause ACE2 receptor up-regulation which raised concerns regarding ACEI and ARB use in COVID-19 patients. However, many medical professional societies recommended their continued use given the paucity of clinical evidence, but there is a need for an updated systematic review and meta-analysis of the latest clinical studies. METHODS AND
resultsA search was conducted on PubMed, Google Scholar, EMBASE, and various preprint servers for studies comparing clinical outcomes and mortality in COVID-19 patients on ACEIs and/or ARBs, and a meta-analysis was performed. A total of 16 studies were included for the review and meta-analysis. There were conflicting findings reported in the rates of severity and mortality in several studies. In a pooled analysis of four studies, there was a statistically non-significant association of ACEI/ARB use with lower odds of developing severe disease vs. non-users [odds ratio (OR) = 0.81, 95% confidence interval (CI): 0.41-1.58, I2=50.52, P-value = 0.53). In a pooled analysis of six studies, there was a statistically non-significant association of ACEI/ARB use with lower odds of mortality as compared with non-users (OR = 0.86, 95% CI = 0.53-1.41, I2 = 79.12, P-value = 0.55).
conclusionIt is concluded that ACEIs and ARBs should be continued in COVID-19 patients, reinforcing the recommendations made by several medical societies. Additionally, the individual patient factors such as ACE2 polymorphisms which might confer higher risk of adverse outcomes need to be evaluated further.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.