ACE inhibitors, ARBs do not pose additional risk in COVID-19 in two meta-analyses
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Use of ACE inhibitors and angiotensin receptor blockers was not associated with an increased rate of COVID-19 infection or mortality, according to two meta-analyses reported at the virtual American Heart Association Scientific Sessions.
Yujiro Yokoyama, MD, surgeon at St. Luke’s University Health Network’s Easton Hospital, Bethlehem, Pennsylvania, and colleagues conducted two meta-analyses to compare mortality and susceptibility to COVID-19 infection between patients treated and not treated with ACE inhibitors and/or angiotensin receptor blockers. The first meta-analysis evaluated the impact on rate of positive COVID-19 testing and the second meta-analysis evaluated the impact on in-hospital mortality for patients with COVID-19.
Researchers examined MEDLINE and EMBASE databases to identify studies that detailed patients treated with ACE inhibitors and/or angiotensin receptor blocks. Their search yielded three eligible studies for the first meta-analysis and 14 eligible studies for the second meta-analysis.
Positive COVID-19 testing rates were similar for patients treated with ACE inhibitors compared with those who did not receive ACE inhibitors (OR = 0.96; 95% CI, 0.88-1.04; P = .69) and for patients treated with angiotensin receptor blockers compared with those not treated with angiotensin receptor blockers (OR = 0.99; 95% CI, 0.91-1.08; P = .35), according to the abstract.
Rates of in-hospital mortality for patients who tested positive for COVID-19 infection were similar between patients treated with ACE inhibitors and/or angiotensin receptor blockers and those who did not receive either medication (HR = 0.88; 95% CI, 0.64-1.2; P = .42), according to the abstract.
In a subanalysis restricted to studies that only investigated patients with hypertension, use of ACE inhibitors and/or angiotensin receptor blockers was associated with a significant reduction in in-hospital mortality compared with no use of either medication (HR = 0.65; 95% CI, 0.48-0.87), according to the abstract.
“Our study results confirm that patients already taking ACE inhibitors and angiotensin receptor blockers should not discontinue takin them due to COVID-19 infection,” Yokoyama said in a press release. “Both medications have proven benefits for heart and kidney disease, and this further confirms previous findings that ACE inhibitors do not pose additional risk with COVID-19.”
Earlier this year, the AHA, Heart Failure Society of America and American College of Cardiology issued a joint statement calling for the continuation of ACE inhibitors and angiotensin receptor blockers during the COVID-19 pandemic in patients prescribed these medications for HF, hypertension and/or ischemic heart disease, and recommended that patients with COVID-19 should be fully evaluated before any treatment changes.
Reference:
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Yokoyama Y, et al. COVID-19: Risk scores and risk factors for adverse outcomes. Presented at: American Heart Association Scientific Sessions; Nov. 13-17, 2020 (virtual meeting).
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