Mortality and disease severity among COVID-19 patients with hypertension
receiving renin-angiotensin system inhibitors
The use of renin-angiotensin system (RAS) inhibitors, including
angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin
receptor blockers (ARBs), is alleged to cause a more severe course of
novel coronavirus disease 2019 (COVID-19). We systematically reviewed
the available studies to assess the association of RAS inhibitors with
mortality as well as disease severity in COVID-19 patients. A systematic
literature search was performed to retrieve relevant original studies
investigating mortality and severity (critical disease) in COVID-19
patients with and without exposure to ACEIs/ARBs. A total of 13 original
studies were included; 11 studies reporting on mortality and 10 studies
reporting on disease severity in ACEI/ARB exposed and unexposed groups.
Among hypertensive COVID-19 patients, the use of ACEI/ARB was associated
with a significant reduction in the risk of mortality exhibiting a
pooled relative risk of 0.73 (95% confidence interval: 0.63-0.86).
Moreover, there was no significant difference in the risk of developing
severe/critical COVID-19 disease between ACEI/ARB and non-ACEI/ARB
groups showing relative risk of 0.72 (95% confidence interval:
0.46-1.12). The data indicate that the use of ACEI/ARB was associated
with reduced risk of mortality in COVID-19 patients taking these
medications to manage their hypertension.