key: cord-0967828-r5gms09p
authors: Mackey, Katherine; Kansagara, Devan; Vela, Kathryn
title: Update Alert 2: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults
date: 2020-07-23
journal: Ann Intern Med
DOI: 10.7326/l20-0969
sha: 376f4c312c19bac240bc3bc7a7f83230841970d0
doc_id: 967828
cord_uid: r5gms09p

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In this second monthly update of our living review (1), we searched MEDLINE (Ovid) weekly from 9 June 9 to 6 July 2020 using the same search strategy as described in the original review. We did not limit by language. This search update yielded 91 results (de-duplicated). After an independent dualreview process, we identified 3 new meta-analyses, 5 new observational studies, and 1 in-progress trial for inclusion.

Results of 3 new meta-analysis (2-4) evaluating the association of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB) use with coronavirus disease 2019 (COVID-19) illness severity are consistent with the findings that we reported in the original manuscript. Five new observational studies also examine this association. Four of these studies found that use of ACEIs or ARBs is not associated with more severe COVID-19 illness (5) (6) (7) (8) . In a retrospective study of 113 patients hospitalized with COVID-19 in Turkey, use of ACEI/ARBs was associated with higher inhospital mortality (9). However, a major limitation of the study is that the group of patients taking ACEI/ARBs were older and more likely to have coronary artery disease than the non-ACEI/ARB group.

Overall, inclusion of these 3 new meta-analyses and 5 new observational studies does not change the certainty of evidence rating we reported in the original manuscript for key question 2-high-certainty evidence that ACEI or ARB use is not associated with more severe COVID-19 disease.

We identified 1 randomized controlled trial that is currently in progress in the Netherlands comparing ARB therapy (valsartan) with placebo on intensive care unit admission, mechanical ventilation, and death among hospitalized adults with COVID-19 (10). The estimated study completion date is December 2021.

A study by Yang and colleagues (11) that was included in our original manuscript as a preprint has now been published.

Risks and impact of angiotensinconverting enzyme inhibitors or angiotensin-receptor blockers on SARS-CoV-2 infection in adults

Treatment with ACE inhibitors or ARBs and risk of severe/lethal COVID-19: a meta-analysis. Heart

A systematic review and meta-analysis to evaluate the clinical outcomes in COVID-19 patients on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Eur Heart J Cardiovasc Pharmacother

Estimation of renin-angiotensin-aldosterone-system (RAAS)-inhibitor effect on COVID-19 outcome: a meta-analysis

Predictors of severe or lethal COVID-19, including angiotensin converting enzyme inhibitors and angiotensin ii receptor blockers, in a sample of infected Italian citizens

Clinical characteristics and disease progression in early-stage COVID-19 patients in South Korea

Use of RAAS inhibitors and risk of clinical deterioration in COVID-19: results from an Italian cohort of 133 hypertensives

Association of angiotensinconverting enzyme inhibitor or angiotensin receptor blocker use with COVID-19 diagnosis and mortality

Is the use of ACE inb/ARBs associated with higher in-hospital mortality in Covid-19 pneumonia patients?

Rationale and design of the PRAETORIAN-COVID trial: a double-blind, placebocontrolled randomized clinical trial with valsartan for prevention of acute respiratory distress syndrome in hospitalized patients with SARS-COV-2 Infection Disease

Effects of angiotensin II receptor blockers and ACE (angiotensin-converting enzyme) inhibitors on virus infection, inflammatory status, and clinical outcomes in patients with COVID-19 and hypertension: a single-center retrospective study

This article was published at Annals.org on 23

Annals of Internal Medicine 1