Abstract 14051: Meta-analyses for the Effect of Renin-angiotensin-aldosterone System Inhibitors on Mortality and Testing Positive of Covid-19

Abstract

Introduction: Some have hypothesized that the use of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARB) may modify susceptibility to coronavirus disease 2019 (COVID-19) in humans. Thus, we conducted two meta-analyses to compare mortality and susceptibility of COVID-19 between those who were treated with ACEI and/or ARB and those who were not treated with ACEI or ARB. Methods: MEDLINE and EMBASE were searched through June 2020 to identify clinical trials that investigated the mortality and testing positive rates for COVID-19 for those who were treated with ACEI or/and ARB and for those who were not treated with ACEI or ARB. The first analysis investigated the testing positive rate of COVID-19. The second analysis investigated the in-hospital mortality rate for patients with COVID-19. Result: 3 eligible studies for the first analysis and 14 eligible studies for the second analysis were identified. The first analysis demonstrated that the testing positive rates were similar for those who were treated with ACEI and for those who were not treated with ACEI (odds ratio [OR] [confidence interval [CI]] =0.96 [0.88-1.04], p =0.69) and for those who were treated with ARB and for those who were not treated with ARB (OR [CI] =0.99 [0.91-1.08], p =0.35) (Figure 1A,B). The second analysis showed that in-hospital mortality for patients with positive COVID-19 was similar between for those who were on ACEI and/or ARB and for those who were not on ACEI or ARB (hazard ratio [HR] [95% [CI]] =0.88 [0.64-1.20], p =0.42) (Figure 2). The subanalysis by restricting studies only investigating patients with hypertension showed ACEI and/or ARB use was associated with a significant reduction of in-hospital mortality compared with no ACEI or ARB use (HR [CI] =0.65 [0.48-0.87]). Conclusion: Our analysis demonstrated that ACEI and/or ARB use was not associated with positive rates of COVID-19, and not associated with mortality of COVID-19 patients.