Department of Internal Medicine, Cardiology, UC Davis, Davis, CA, USA.
Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China.
J Cardiol. 2021 May;77(5):482-491. doi: 10.1016/j.jjcc.2020.10.015. Epub 2020 Nov 2.
The association of antihypertensive drugs with the risk and severity of COVID-19 remains unknown.
We systematically searched PubMed, MEDLINE, The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and medRxiv for publications before July 13, 2020. Cohort studies and case-control studies that contain information on the association of antihypertensive agents including angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), calcium-channel blockers (CCBs), β-blockers, and diuretics with the risk and severity of COVID-19 were selected. The random or fixed-effects models were used to pool the odds ratio (OR) with 95% confidence interval (CI) for the outcomes. The literature search yielded 53 studies that satisfied our inclusion criteria, which comprised 39 cohort studies and 14 case-control studies. These studies included a total of 2,100,587 participants. We observed no association between prior usage of antihypertensive medications including ACEIs/ARBs, CCBs, β-blockers, or diuretics and the risk and severity of COVID-19. Additionally, when only hypertensive patients were included, the severity and mortality were lower with prior usage of ACEIs/ARBs (overall OR of 0.81, 95% CI 0.66-0.99, p < 0.05 and overall OR of 0.77, 95% CI 0.66-0.91, p < 0.01).
Taken together, usage of antihypertensive drugs is not associated with the risk and severity of COVID-19. Based on the current available literature, it is not recommended to abstain from the usage of these drugs in COVID-19 patients.
The meta-analysis was registered on OSF (https://osf.io/ynd5g).
降压药物与 COVID-19 风险和严重程度的关联尚不清楚。
我们系统地检索了 PubMed、MEDLINE、The Cochrane Library、Cochrane 中央对照试验注册库（CENTRAL）、ClinicalTrials.gov 和 medRxiv，以获取 2020 年 7 月 13 日前发表的文献。选择包含有关降压药物（包括血管紧张素转换酶抑制剂[ACEI]、血管紧张素 II 受体阻滞剂[ARB]、钙通道阻滞剂[CCB]、β受体阻滞剂和利尿剂）与 COVID-19 风险和严重程度关联的队列研究和病例对照研究。使用随机或固定效应模型汇总结局的比值比（OR）及其 95%置信区间（CI）。文献检索得到 53 项符合纳入标准的研究，其中包括 39 项队列研究和 14 项病例对照研究。这些研究共纳入了 2100587 名参与者。我们没有发现先前使用降压药物（包括 ACEI/ARB、CCB、β受体阻滞剂或利尿剂）与 COVID-19 的风险和严重程度之间存在关联。此外，当仅纳入高血压患者时，先前使用 ACEI/ARB 与 COVID-19 的严重程度和死亡率较低（总体 OR 为 0.81，95%CI 为 0.66-0.99，p<0.05；总体 OR 为 0.77，95%CI 为 0.66-0.91，p<0.01）。
总的来说，降压药物的使用与 COVID-19 的风险和严重程度无关。根据目前的可用文献，不建议 COVID-19 患者停止使用这些药物。
该荟萃分析已在 OSF 上注册（https://osf.io/ynd5g）。
