CV drugs not linked to poor outcomes in patients at high risk for COVID-19
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In a cohort of patients with COVID-19, along with those at high risk for COVID-19, CV drug use was not associated with poor clinical outcomes, researchers reported.
“Patients should continue taking these drugs as prescribed,” Innocent G. Asiimwe, PhD student in the department of pharmacology and therapeutics at the University of Liverpool, United Kingdom, and colleagues wrote in the British Journal of Clinical Pharmacology.
For the study, Asiimwe and colleagues aimed to determine the association between CV drug exposure and COVID-19 clinical outcomes in patients at risk for or with confirmed COVID-19. They identified eligible publications from more than 500 databases on Nov. 1, 2020. According to study methodology, one reviewer extracted data and a second reviewer independently extracted/evaluated 20% of the records.
The study included 52,735 screened records, with 429 studies included in the qualitative synthesis and 390 studies in the quantitative synthesis. The researchers found that ACE inhibitors/angiotensin receptor blockers were the most reported drugs, and that exposure to these drugs had a borderline association with confirmed COVID-19 infection (OR = 1.14; 95% CI, 1-1.31).
Unadjusted estimates in patients with COVID-19 indicated that ACE inhibitor/angiotensin receptor blocker exposure was associated with hospitalization (OR = 1.76; 95% CI, 1.34-2.32), disease severity (OR = 1.4; 95% CI, 1.26-1.55) and all-cause mortality (OR = 1.22; 95% CI, 1.12-1.33), but not hospitalization length (mean difference, –0.27 days; 95% CI, –1.36 to 0.82).
However, in an adjusted analysis, ACE inhibitor/angiotensin receptor blocker exposure failed to increase the odds for COVID-19 infection (OR = 0.92; 95% CI, 0.71-1.19), hospitalization (OR = 0.93; 95% CI, 0.7-1.24), disease severity (OR = 1.05; 95% CI, 0.81-1.38) or all-cause mortality (OR = 0.84; 95% CI, 0.7-1).
Among patients with hypertension, ACE inhibitor/angiotensin receptor blocker exposure decreased the likelihood of dying (OR = 0.76; 95% CI, 0.65-0.88), but did not influence the odds of COVID-19 infection (OR = 0.93; 95% CI, 0.79-1.09), hospitalization (OR = 0.84; 95% CI, 0.58-1.22), hospitalization length (mean difference, –0.14 days; 95% CI, –1.65 to 1.36) or disease severity (OR = 0.92; 95% CI, 0.76-1.11). Similar trends were observed with other CV drugs.
The researchers cautioned that the study represents low- to moderate-certainty evidence, and that a high level of heterogeneity and serious risk for bias limits the validity of their findings. More high-quality evidence from randomized controlled trials “is urgently required and will be the focus of our next systematic review update. As we await further evidence, patients on cardiovascular drugs should continue taking their medications as is recommended worldwide for ACE inhibitors/angiotensin receptor blockers,” Asiimwe and colleagues wrote.
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