Severity of SARS-Cov-2 infection and angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers: a meta-analysis

Abstract

Background: The mechanism of entry of SARS-CoV-2 into the human host cell is through the ACE2 receptor. During the pandemic, a hypothesis has been proposed that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) could be risk factors for the development of severe SARS-CoV-2 infection.The objective of the study was to conduct a meta-analysis of the association between ACEI or ARB use and SARS-CoV-2 infection severity or mortality. Data Sources: We searched PubMed, EMBASE, Google scholar and the Cochrane Database of Systematic Reviews for observational studies published between December 2019 and August 4, 2020. Study Selection: Studies were included if they contained data on ACEIor ARB use and SARS-CoV-2 infection severity or mortality. Effect statistics were pooled using random-effects models. The quality of included studies was assessed with the Newcastle–Ottawa Scale (NOS). Data extraction: Data on study design, study location, year of publication, number of participants, sex, age at baseline, outcome definition, exposure definition, effect estimates and 95% CIs. Results: Twenty-six studies (21cohort studies and 5 case-control studies) were identified for inclusion,combining to a total sample of 361467 participants. Mean age was 61.48 (SD8.26) years and 51.63 % were men. The mean NOS score of included studies was 7.85 (range: 7–9). Results suggested that ACEI or ARB use did not increase the risk of severe disease or mortality from SARS-CoV-2 infection (OR=0.88, 95% CI:0.75–1.02, p>0.05). Conclusions: At present, the evidence available does not support the hypothesis of increased SARS-CoV-2 risk with ACEI or ARB drugs.