Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Dongjak-gu, Seoul, The Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, The Republic of Korea.
Thorax. 2021 May;76(5):479-486. doi: 10.1136/thoraxjnl-2020-215322. Epub 2021 Jan 27.
The association of ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) with disease severity of patients with COVID-19 is still unclear. We conducted a systematic review and meta-analysis to investigate if ACEI/ARB use is associated with the risk of mortality and severe disease in patients with COVID-19.
We searched all available clinical studies that included patients with confirmed COVID-19 who could be classified into an ACEI/ARB group and a non-ACEI/ARB group up until 4 May 2020. A meta-analysis was performed, and primary outcomes were all-cause mortality and severe disease.
ACEI/ARB use did not increase the risk of all-cause mortality both in meta-analysis for 11 studies with 12 601 patients reporting ORs (OR=0.52 (95% CI=0.37 to 0.72), moderate certainty of evidence) and in 2 studies with 8577 patients presenting HRs. For 12 848 patients in 13 studies, ACEI/ARB use was not related to an increased risk of severe disease in COVID-19 (OR=0.68 (95% CI=0.44 to 1.07); I=95%, low certainty of evidence).
ACEI/ARB therapy was not associated with increased risk of all-cause mortality or severe manifestations in patients with COVID-19. ACEI/ARB therapy can be continued without concern of drug-related worsening in patients with COVID-19.
血管紧张素转换酶抑制剂（ACEI）和血管紧张素 II 受体阻滞剂（ARB）与 COVID-19 患者疾病严重程度的关系尚不清楚。我们进行了一项系统评价和荟萃分析，以调查 ACEI/ARB 的使用是否与 COVID-19 患者的死亡风险和重症疾病相关。
我们检索了截至 2020 年 5 月 4 日所有包含确诊 COVID-19 患者的临床研究，这些患者可分为 ACEI/ARB 组和非 ACEI/ARB 组。进行荟萃分析，主要结局是全因死亡率和重症疾病。
ACEI/ARB 治疗与 11 项研究（12601 例患者）的汇总 OR（OR=0.52（95%CI=0.37 至 0.72），证据确定性为中等）和 2 项研究（8577 例患者）的 HR 均不增加全因死亡率风险。在 13 项研究（12848 例患者）中，ACEI/ARB 治疗与 COVID-19 患者重症疾病风险增加无关（OR=0.68（95%CI=0.44 至 1.07）；I=95%，证据确定性低）。
ACEI/ARB 治疗与 COVID-19 患者全因死亡率或重症表现风险增加无关。COVID-19 患者可以继续 ACEI/ARB 治疗，而不必担心与药物相关的病情恶化。
