Effects of ACEIs and ARBs on Clinical Outcomes in COVID-19 Patients: A Meta-Analysis

Background: Role of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in the treatment of coronavirus disease 2019 (COVID-19) patients is highly debated. It was aimed to build a robust evidence by investigating the associations between ACEIs/ARBs use and the risk of deaths or severe clinical manifestations or magnitude of SARS-CoV-2 positive test in patients hospitalized for SARS-CoV-2 infection. Methods: Systematic literature search was carried out in different databases for eligible studies. The pooled effect was measured using RevMan software where P<0.05 (2-sided) was set as statistical significance. Findings: In total, seven studies were included in this analysis in which 1,704 SARS-CoV-2 positive patients were taking ACEIs/ARBs whereas 4,087 positive patients were non users of ACEIs/ARBs. It was demonstrated that SARS-CoV-2 positive patients taking ACEIs/ARBs were associated with a trend towards reduction of the risk of deaths as compared to those not taking ACEIs/ARBs, although statistically insignificant (RR 0.70; 95% CI 0.39-1.26; P=0.24). Further, the risk of composite severe clinical manifestations (admitted to ICU/using mechanical ventilation/deaths) was not found significantly different between the positive patients with or without ACEIs/ARBs users (RR 1.52; 95% CI 0.77-3.03; P=0.23). Interestingly, there was no risk difference for SARS-CoV-2 test positivity in patients with or without ACEIs/ARBs users (RR 1.00; 95% CI 0.95-1.05; P=0.91). Interpretation: The findings of this analysis indicated that using ACEIs/ARBs in SARS-CoV-2 positive patients were not associated with increased risk of mortality, severe clinical manifestations and viral infectivity that are augmenting current professional society guidelines for not discontinuing ACEIs/ARBs in treating COVID-19 patients.Funding Statement: None.Declaration of Interests: None.