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Mortality and disease severity among COVID-19 patients with hypertension receiving renin-angiotensin system inhibitors
  • Syed Shahzad Hasan,
  • Chia Siang Kow,
  • Hamid Merchant
Syed Shahzad Hasan
University of Huddersfield
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Chia Siang Kow
International Medical University
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Hamid Merchant
University of Huddersfield
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Abstract

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.