Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults: A Living Systematic Review
- PMID: 32422062
- PMCID: PMC7249560
- DOI: 10.7326/M20-1515
Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults: A Living Systematic Review
Update in
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Update Alert 7: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults.Ann Intern Med. 2021 Feb;174(2):W25-W29. doi: 10.7326/L20-1446. Epub 2021 Jan 5. Ann Intern Med. 2021. PMID: 33395346 Free PMC article. No abstract available.
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Update Alert 8: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults.Ann Intern Med. 2021 Jun;174(6):W54-W55. doi: 10.7326/L21-0223. Epub 2021 Apr 27. Ann Intern Med. 2021. PMID: 33900794 Free PMC article. No abstract available.
Abstract
Background: The role of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) in coronavirus disease 2019 (COVID-19) susceptibility, severity, and treatment is unclear.
Purpose: To evaluate, on an ongoing basis, whether use of ACEIs or ARBs either increases risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or is associated with worse COVID-19 disease outcomes, and to assess the efficacy of these medications for COVID-19 treatment.
Data sources: MEDLINE (Ovid) and Cochrane Database of Systematic Reviews from 2003 to 4 May 2020, with planned ongoing surveillance for 1 year; the World Health Organization database of COVID-19 publications and medRxiv.org through 17 April 2020; and ClinicalTrials.gov to 24 April 2020, with planned ongoing surveillance.
Study selection: Observational studies and trials in adults that examined associations and effects of ACEIs or ARBs on risk for SARS-CoV-2 infection and COVID-19 disease severity and mortality.
Data extraction: Single-reviewer abstraction confirmed by another reviewer, independent evaluation by 2 reviewers of study quality, and collective assessment of certainty of evidence.
Data synthesis: Two retrospective cohort studies found that ACEI and ARB use was not associated with a higher likelihood of receiving a positive SARS-CoV-2 test result, and 1 case-control study found no association with COVID-19 illness in a large community (moderate-certainty evidence). Fourteen observational studies, involving a total of 23 565 adults with COVID-19, showed consistent evidence that neither medication was associated with more severe COVID-19 illness (high-certainty evidence). Four registered randomized trials plan to evaluate ACEIs and ARBs for treatment of COVID-19.
Limitation: Half the studies were small and did not adjust for important confounding variables.
Conclusion: High-certainty evidence suggests that ACEI or ARB use is not associated with more severe COVID-19 disease, and moderate-certainty evidence suggests no association between use of these medications and positive SARS-CoV-2 test results among symptomatic patients. Whether these medications increase the risk for mild or asymptomatic disease or are beneficial in COVID-19 treatment remains uncertain.
Primary funding source: None. (PROSPERO: registration number pending).
Figures
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![Figure 2.](https://webcf.waybackmachine.org/web/20220408220619im_/https://www.ncbi.nlm.nih.gov/pmc/articles/instance/7249560/bin/aim-olf-M201515-M201515ff2.gif)
Comment in
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COVID-19 and Angiotensin-Converting Enzyme Inhibitor/Angiotensin-Receptor Blocker Therapy.Ann Intern Med. 2020 Aug 4;173(3):237-238. doi: 10.7326/M20-3047. Epub 2020 May 15. Ann Intern Med. 2020. PMID: 32422077 Free PMC article.
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Update Alert: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults.Ann Intern Med. 2020 Aug 4;173(3):W66. doi: 10.7326/L20-0887. Epub 2020 Jun 25. Ann Intern Med. 2020. PMID: 32584593 Free PMC article. No abstract available.
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Update Alert 2: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults.Ann Intern Med. 2020 Sep 1;173(5):W87. doi: 10.7326/L20-0969. Epub 2020 Jul 23. Ann Intern Med. 2020. PMID: 32701362 Free PMC article. No abstract available.
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Update Alert 3: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults.Ann Intern Med. 2020 Oct 6;173(7):130-131. doi: 10.7326/L20-1068. Epub 2020 Aug 26. Ann Intern Med. 2020. PMID: 32845705 Free PMC article. No abstract available.
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Update Alert 4: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults.Ann Intern Med. 2020 Nov 3;173(9):W147-W148. doi: 10.7326/L20-1177. Epub 2020 Sep 22. Ann Intern Med. 2020. PMID: 32956599 Free PMC article. No abstract available.
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Update Alert 5: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults.Ann Intern Med. 2020 Dec 15;173(12):167-168. doi: 10.7326/L20-1293. Epub 2020 Oct 27. Ann Intern Med. 2020. PMID: 33105094 Free PMC article. No abstract available.
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Update Alert 6: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults.Ann Intern Med. 2021 Jan;174(1):W17. doi: 10.7326/L20-1355. Epub 2020 Dec 1. Ann Intern Med. 2021. PMID: 33253036 Free PMC article. No abstract available.
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Update Alert 9: Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults.Ann Intern Med. 2022 Feb 8:L21-0791. doi: 10.7326/L21-0791. Online ahead of print. Ann Intern Med. 2022. PMID: 35130048 Free PMC article. No abstract available.
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