TY - JOUR
T1 - Renin-Angiotensin System Inhibitors in Patients With COVID-19
T2 - A Meta-Analysis of Randomized Controlled Trials Led by the International Society of Hypertension
AU - COVID‐METARASI Consortium
AU - Gnanenthiran, Sonali R
AU - Borghi, Claudio
AU - Burger, Dylan
AU - Caramelli, Bruno
AU - Charchar, Fadi
AU - Chirinos, Julio A
AU - Cohen, Jordana B
AU - Cremer, Antoine
AU - Di Tanna, Gian Luca
AU - Duvignaud, Alexandre
AU - Freilich, Daniel
AU - Gommans, D H Frank
AU - Gracia-Ramos, Abraham E
AU - Murray, Thomas A
AU - Pelorosso, Facundo
AU - Poulter, Neil R
AU - Puskarich, Michael A
AU - Rizas, Konstantinos D
AU - Rothlin, Rodolfo
AU - Schlaich, Markus P
AU - Schreinlecher, Michael
AU - Steckelings, Ulrike Muscha
AU - Sharma, Abhinav
AU - Stergiou, George S
AU - Tignanelli, Christopher J
AU - Tomaszewski, Maciej
AU - Unger, Thomas
AU - van Kimmenade, Roland R J
AU - Wainford, Richard D
AU - Williams, Bryan
AU - Rodgers, Anthony
AU - Schutte, Aletta E
PY - 2022/9/6
Y1 - 2022/9/6
N2 - Background Published randomized controlled trials are underpowered for binary clinical end points to assess the safety and efficacy of renin-angiotensin system inhibitors (RASi) in adults with COVID-19. We therefore performed a meta-analysis to assess the safety and efficacy of RASi in adults with COVID-19. Methods and Results MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Controlled Trial Register were searched for randomized controlled trials that randomly assigned patients with COVID-19 to RASi continuation/commencement versus no RASi therapy. The primary outcome was all-cause mortality at ≤30 days. A total of 14 randomized controlled trials met the inclusion criteria and enrolled 1838 participants (aged 59 years, 58% men, mean follow-up 26 days). Of the trials, 11 contributed data. We found no effect of RASi versus control on all-cause mortality (7.2% versus 7.5%; relative risk [RR], 0.95; [95% CI, 0.69-1.30]) either overall or in subgroups defined by COVID-19 severity or trial type. Network meta-analysis identified no difference between angiotensin-converting enzyme inhibitors versus angiotensin II receptor blockers. RASi users had a nonsignificant reduction in acute myocardial infarction (2.1% versus 3.6%; RR, 0.59; [95% CI, 0.33-1.06]), but increased risk of acute kidney injury (7.0% versus 3.6%; RR, 1.82; [95% CI, 1.05-3.16]), in trials that initiated and continued RASi. There was no increase in need for dialysis or differences in congestive cardiac failure, cerebrovascular events, venous thromboembolism, hospitalization, intensive care admission, inotropes, or mechanical ventilation. Conclusions This meta-analysis of randomized controlled trials evaluating angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers versus control in patients with COVID-19 found no difference in all-cause mortality, a borderline decrease in myocardial infarction, and an increased risk of acute kidney injury with RASi. Our findings provide strong evidence that RASi can be used safely in patients with COVID-19.
AB - Background Published randomized controlled trials are underpowered for binary clinical end points to assess the safety and efficacy of renin-angiotensin system inhibitors (RASi) in adults with COVID-19. We therefore performed a meta-analysis to assess the safety and efficacy of RASi in adults with COVID-19. Methods and Results MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Controlled Trial Register were searched for randomized controlled trials that randomly assigned patients with COVID-19 to RASi continuation/commencement versus no RASi therapy. The primary outcome was all-cause mortality at ≤30 days. A total of 14 randomized controlled trials met the inclusion criteria and enrolled 1838 participants (aged 59 years, 58% men, mean follow-up 26 days). Of the trials, 11 contributed data. We found no effect of RASi versus control on all-cause mortality (7.2% versus 7.5%; relative risk [RR], 0.95; [95% CI, 0.69-1.30]) either overall or in subgroups defined by COVID-19 severity or trial type. Network meta-analysis identified no difference between angiotensin-converting enzyme inhibitors versus angiotensin II receptor blockers. RASi users had a nonsignificant reduction in acute myocardial infarction (2.1% versus 3.6%; RR, 0.59; [95% CI, 0.33-1.06]), but increased risk of acute kidney injury (7.0% versus 3.6%; RR, 1.82; [95% CI, 1.05-3.16]), in trials that initiated and continued RASi. There was no increase in need for dialysis or differences in congestive cardiac failure, cerebrovascular events, venous thromboembolism, hospitalization, intensive care admission, inotropes, or mechanical ventilation. Conclusions This meta-analysis of randomized controlled trials evaluating angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers versus control in patients with COVID-19 found no difference in all-cause mortality, a borderline decrease in myocardial infarction, and an increased risk of acute kidney injury with RASi. Our findings provide strong evidence that RASi can be used safely in patients with COVID-19.
KW - Acute Kidney Injury/chemically induced
KW - Adult
KW - Angiotensin Receptor Antagonists/pharmacology
KW - Angiotensin-Converting Enzyme Inhibitors/adverse effects
KW - Antihypertensive Agents/therapeutic use
KW - COVID-19
KW - Female
KW - Humans
KW - Hypertension
KW - Male
KW - Myocardial Infarction/drug therapy
KW - Randomized Controlled Trials as Topic
KW - Renin-Angiotensin System
U2 - 10.1161/JAHA.122.026143
DO - 10.1161/JAHA.122.026143
M3 - Review article
C2 - 36000426
SN - 2047-9980
VL - 11
SP - e026143
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 17
ER -