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Angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers and the risk of COVID-19 infection or severe disease: systematic review and meta-analysis

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dc.contributor.authorCaldeira, Daniel
dc.contributor.authorAlves, Mariana
dc.contributor.authorMelo, Ryan
dc.contributor.authorAntónio, Pedro Silvério
dc.contributor.authorCunha, Nelson
dc.contributor.authorNunes-Ferreira, Afonso
dc.contributor.authorPrada, Luísa
dc.contributor.authorCosta, João
dc.contributor.authorPinto, Fausto J.
dc.date.accessioned2020-09-10T15:35:46Z
dc.date.available2020-09-10T15:35:46Z
dc.date.issued2020
dc.description© 2020 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).pt_PT
dc.description.abstractObjective: Animal studies suggested that angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARB) facilitate the inoculation of potentially leading to a higher risk of infection and/or disease severity. We aimed to systematically evaluate the risk of COVID-19 infection and the risk of severe COVID-19 disease associated with previous exposure to (ACEi) and/or ARB). Methods: MEDLINE, CENTRAL, PsycINFO, Web of Science Core Collection were searched in June 2020 for controlled studies. Eligible studies were included and random-effects meta-analyses were performed. The estimates were expressed as odds ratios (OR) and 95% confidence intervals (95%CI). Heterogeneity was assessed with I2 test. The confidence in the pooled evidence was appraised using the GRADE framework. Results: Twenty-seven studies were included in the review. ACEi/ARB exposure did not increase the risk of having a positive test for COVID-19 infection (OR 0.99, 95%CI 0.89–1.11; I2 = 36%; 5 studies, GRADE confidence moderate). The exposure to ACEi/ARB did not increase the risk of all-cause mortality among patients with COVID-19 (OR 0.91, 95%CI 0.74–1.11; I2 = 20%; 17 studies; GRADE confidence low) nor severe/critical COVID-19 disease (OR 0.90, 95%CI 0.74–1.11; I2 = 55%; 17 studies; GRADE confidence very low). Exploratory analyses in studies enrolling hypertensive patients showed a association of ACEi/ARB with a significant decrease of mortality risk. Conclusions: ACEi/ARB exposure does not seem to increase the risk of having the SARS-CoV-2 infection or developing severe stages of the disease including mortality. The potential benefits observed in mortality of hypertensive patients reassure safety, but robust studies are required to increase the confidence in the results.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationIJC Heart & Vasculature 31 (2020) 100627pt_PT
dc.identifier.doi10.1016/j.ijcha.2020.100627pt_PT
dc.identifier.issn2352-9067
dc.identifier.urihttp://hdl.handle.net/10451/44340
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.relation.publisherversionhttps://www.sciencedirect.com/journal/ijc-heart-and-vasculaturept_PT
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/pt_PT
dc.subjectCoronaviruspt_PT
dc.subjectSARS-CoV-2pt_PT
dc.subjectAngiotensin-converting enzyme inhibitorpt_PT
dc.subjectAngiotensin-receptor blockerpt_PT
dc.subjectAcute respiratory distress syndromept_PT
dc.subjectAcute lung injurypt_PT
dc.titleAngiotensin-converting enzyme inhibitors and angiotensin-receptor blockers and the risk of COVID-19 infection or severe disease: systematic review and meta-analysispt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.startPage100627pt_PT
oaire.citation.titleIJC Heart & Vasculaturept_PT
oaire.citation.volume31pt_PT
person.familyNameCaldeira
person.familyNameAlves
person.familyNameGouveia e Melo
person.familyNamePires da Cunha
person.familyNameNunes-Ferreira
person.familyNamePrada
person.familyNameCosta
person.familyNamePinto
person.givenNameDaniel
person.givenNameMariana
person.givenNameRyan
person.givenNameNelson
person.givenNameAfonso
person.givenNameLuísa
person.givenNameJoão
person.givenNameFausto J.
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person.identifier.orcid0000-0002-2520-5673
person.identifier.orcid0000-0002-1369-8423
person.identifier.orcid0000-0001-8327-6384
person.identifier.orcid0000-0002-2836-9497
person.identifier.orcid0000-0002-7082-7594
person.identifier.orcid0000-0002-5831-4921
person.identifier.orcid0000-0002-8034-4529
person.identifier.ridO-3034-2016
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rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
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