Ssentongo Anna E, Ssentongo Paddy, Heilbrunn Emily S, Lekoubou Alain, Du Ping, Liao Duanping, Oh John S, Chinchilli Vernon M
Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA.
Open Heart. 2020 Nov;7(2). doi: 10.1136/openhrt-2020-001353.
The association between the use of renin-angiotensin-aldosterone (RAAS) inhibitors and the risk of mortality from COVID-19 is unclear. We aimed to estimate the association of RAAS inhibitors, including ACE inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) with COVID-19 mortality risk in patients with hypertension.
PubMed (MEDLINE) SCOPUS, OVID, Cochrane Library databases and medrxiv.org were searched from 1 January 2020 to 1 September 2020. Studies reporting the association of RAAS inhibitors (ACEi or ARBs) and mortality in patients with hypertension, hospitalised for COVID-19 were extracted. Two reviewers independently extracted appropriate data of interest and assessed the risk of bias. All analyses were performed using random-effects models on log-transformed risk ratio (RR) estimates, and heterogeneity was quantified.
Fourteen studies were included in the systematic review (n=73,073 patients with COVID-19; mean age 61 years; 53% male). Overall, the between-study heterogeneity was high (I=80%, p<0.01). Patients with hypertension with prior use of RAAS inhibitors were 35% less likely to die from COVID-19 compared with patients with hypertension not taking RAAS inhibitors (pooled RR 0.65, 95% CI 0.45 to 0.94). The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations was graded as 'moderate' quality.
In this meta-analysis, with prior use of RAAS inhibitors was associated with lower risk mortality from COVID-19 in patients with hypertension. Our findings suggest a potential protective effect of RAAS-inhibitors in COVID-19 patients with hypertension.
The present study has been registered with PROSPERO (registration ID: CRD 42020187963).
肾素-血管紧张素-醛固酮系统（RAAS）抑制剂的使用与2019冠状病毒病（COVID-19）死亡风险之间的关联尚不清楚。我们旨在评估RAAS抑制剂，包括血管紧张素转换酶抑制剂（ACEi）和血管紧张素II受体阻滞剂（ARBs）与高血压患者COVID-19死亡风险之间的关联。
检索2020年1月1日至2020年9月1日期间的PubMed（MEDLINE）、SCOPUS、OVID、Cochrane图书馆数据库和medrxiv.org。提取报告RAAS抑制剂（ACEi或ARBs）与因COVID-19住院的高血压患者死亡率之间关联的研究。两名审阅者独立提取相关数据并评估偏倚风险。所有分析均使用随机效应模型对对数转换风险比（RR）估计值进行，对异质性进行量化。
系统评价纳入了14项研究（n = 73,073例COVID-19患者；平均年龄61岁；53%为男性）。总体而言，研究间异质性较高（I = 80%，p < 0.01）。与未服用RAAS抑制剂的高血压患者相比，先前使用RAAS抑制剂的高血压患者死于COVID-19的可能性降低35%（合并RR 0.65，95%CI 0.45至0.94）。根据推荐分级、评估、制定和评价分级的证据质量被评为“中等”质量。
在这项荟萃分析中，先前使用RAAS抑制剂与高血压患者COVID-19死亡风险较低相关。我们的研究结果表明RAAS抑制剂对患有高血压的COVID-19患者具有潜在的保护作用。
国际前瞻性系统评价注册库（PROSPERO）注册号：本研究已在PROSPERO注册（注册号：CRD 42020187963）。
