SynthesisHeart (British Cardiac Society)2020
Treatment with ACE inhibitors or ARBs and risk of severe/lethal COVID-19: a meta-analysis.
Synthesis in Heart (British Cardiac Society), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 63 papers, 9 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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
63 citing papers in PubMed, 9 syntheses or guidelines pooled it, 105 citations in OpenAlex.
- An umbrella review and meta-analysis of renin-angiotensin system drugs use and COVID-19 outcomes.European journal of clinical investigation · 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
- COVID-19 vaccines reduce the risk of SARS-CoV-2 reinfection and hospitalization: Meta-analysis.Frontiers in medicine · 2022Pooled it
- Influence of angiotensin converting enzyme inhibitors/angiotensin receptor blockers on the risk of all-cause mortality and other clinical outcomes in patients with confirmed COVID-19: A systemic review and meta-analysis.Journal of clinical hypertension (Greenwich, Conn.) · 2021Pooled it
- Lack of association of antihypertensive drugs with the risk and severity of COVID-19: A meta-analysis.Journal of cardiology · 2021Pooled it
- Treatment of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and coronavirus disease 2019 (COVID-19): a systematic review ofTheranostics · 2021Pooled 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
- RAAS inhibitors are not associated with mortality in COVID-19 patients: Findings from an observational multicenter study in Italy and a meta-analysis of 19 studies.Vascular pharmacology · 2020Pooled it
- Update of the recommendations of the Sociedade Portuguesa de Cuidados Intensivos and the Infection and Sepsis Group for the approach to COVID-19 in Intensive Care Medicine.Revista Brasileira de terapia intensivaPooled it
- Article
- A machine learning model exploring the relationship between chronic medication and COVID-19 clinical outcomes.International journal of clinical pharmacy · 2025Article
- Paracetamol Use and COVID-19 Clinical Outcomes: A Meta-Analysis.Healthcare (Basel, Switzerland) · 2024Review
- Losartan and enalapril maleate differently influence SARS-CoV-2-infected vero cells.Scientific reports · 2024Article
- The Bidirectional Association Between Metabolic Syndrome and Long-COVID-19.Diabetes, metabolic syndrome and obesity : targets and therapy · 2024Review
- Timing matters in the use of renin-angiotensin system modulators and COVID-related cognitive and cerebrovascular dysfunction.PloS one · 2024Article
- STUDY HYPOTHESIS: AGE, GENDER, PRESENCE OF DIABETES MELLITUS OR HYPERTENSION, AND ANTI-HYPERTENSIVE DRUGS ARE INDEPENDENT RISK FACTORS FOR COVID-19 MORTALITY.Acta clinica Croatica · 2023Article
- 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
- Development of a Risk Score for AKI onset in COVID-19 Patients: COV-AKI Score.BMC nephrology · 2023Observational
- Angiotensin-Converting Enzyme 2 Expression and Severity of SARS-CoV-2 Infection.Microorganisms · 2023Review
- New Viral Diseases and New Possible Remedies by Means of the Pharmacology of the Renin-Angiotensin System.Journal of the renin-angiotensin-aldosterone system : JRAAS · 2023Review
3 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
9 authors at 6 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveIt has been hypothesised that the use of ACE inhibitors and angiotensin receptor blockers (ARBs) might either increase or reduce the risk of severe or lethal COVID-19. The findings from the available observational studies varied, and summary estimates are urgently needed to elucidate whether these drugs should be suspended during the pandemic, or patients and physicians should be definitely reassured. This meta-analysis of adjusted observational data aimed to summarise the existing evidence on the association between these medications and severe/lethal COVID-19.
methodsWe searched MedLine, Scopus and preprint repositories up to 8 June 2020 to retrieve cohort or case-control studies comparing the risk of severe/fatal COVID-19 (either mechanical ventilation, intensive care unit admission or death), among hypertensive subjects treated with: (1) ACE inhibitors, (2) ARBs and (3) both, versus untreated subjects. Data were combined using a random-effect generic inverse variance approach.
resultsTen studies, enrolling 9890 hypertensive subjects were included in the analyses. Compared with untreated subjects, those using either ACE inhibitors or ARBs showed a similar risk of severe or lethal COVID-19 (summary OR: 0.90; 95% CI 0.65 to 1.26 for ACE inhibitors; 0.92; 95% CI 0.75 to 1.12 for ARBs). The results did not change when both drugs were considered together, when death was the outcome and excluding the studies with significant, divergent results.
conclusionThe present meta-analysis strongly supports the recommendation of several scientific societies to continue ARBs or ACE inhibitors for all patients, unless otherwise advised by their physicians who should thus be reassured.
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What OpenQuestion holds
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.