The effect of renin-angiotensin-aldosterone system inhibitors in patients with hypertension and COVID-19: A meta-analysis of randomized controlled trials and propensity score-matched studies.
The effect of renin-angiotensin-aldosterone system inhibitors in patients with hypertension and COVID-19: A meta-analysis of randomized controlled trials and propensity score-matched studies.
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DOI：
10.1016/j.jointm.2022.05.004
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发表时间：
2022-10
期刊：
影响因子：
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通讯作者：
Zhang, Shufang
中科院分区：
文献类型：
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作者：
Zhang, Kai;Cao, Lanxin;Xuan, Nanxia;Huang, Tiancha;Tian, Baoping;Cui, Wei;Zhang, Gensheng;Zhang, Shufang
缺乏高质量的证据来证明使用肾素-血管紧张素-醛固酮系统（RAAS）抑制剂是否会恶化2019冠状病毒病（COVID-19）患者的临床结果。本研究旨在通过随机对照试验（rct）和倾向评分匹配（PSM）研究评估RAAS抑制剂对高血压和COVID-19患者疾病严重程度和死亡率的影响。从2019年12月31日至2022年1月10日，对PubMed、Embase和Scopus数据库进行文献检索。我们纳入了rct和PSM研究，比较了接受或未接受RAAS抑制剂治疗的高血压和COVID-19患者的严重疾病或死亡风险。采用随机效应模型，将单个试验数据合并估计合并优势比（OR）。meta分析共纳入17项研究（4项rct和13项PSM研究）。RAAS抑制剂的使用与高血压和COVID-19患者严重疾病风险（OR=1.00, 95%可信区间[CI]: 0.88-1.14, I2=28%）或死亡率（OR=0.96, 95% CI: 0.83-1.11, I2=16%）的增加无关。此外，患者继续或停止使用RAAS抑制剂治疗时，COVID-19的严重程度无显著差异（or =1.01, 95% CI: 0.78-1.29, I2=0%）。该研究表明，使用RAAS抑制剂治疗与恶化的COVID-19疾病结局之间没有关联。我们的研究结果支持目前的指南，即在COVID-19大流行的情况下应继续使用RAAS抑制剂。然而，RAAS抑制剂药物对COVID-19患者的益处需要通过更多的随机对照试验进一步验证。
High-quality evidence for whether the use of renin–angiotensin–aldosterone system (RAAS) inhibitors worsens clinical outcomes for patients with coronavirus disease 2019 (COVID-19) is lacking. The present study aimed to evaluate the effect of RAAS inhibitors on disease severity and mortality in patients with hypertension and COVID-19 using randomized controlled trials (RCTs) and propensity score-matched (PSM) studies. A literature search was conducted with PubMed, Embase, and Scopus databases from 31 December 2019 to 10 January 2022. We included RCTs and PSM studies comparing the risk of severe illness or mortality in patients with hypertension and COVID-19 treated or not treated with RAAS inhibitors. Individual trial data were combined to estimate the pooled odds ratio (OR) with a random-effects model. A total of 17 studies (4 RCTs and 13 PSM studies) were included in the meta-analysis. The use of RAAS inhibitors was not associated with an increased risk of severe illness (OR=1.00, 95% confidence interval [CI]: 0.88–1.14, I2=28%) or mortality (OR=0.96, 95% CI: 0.83–1.11, I2=16%) for patients with hypertension and COVID-19. Furthermore, there was no significant difference in the severity of COVID-19 when patients continued or discontinued treatment with RAAS inhibitors (OR=1.01, 95% CI: 0.78–1.29, I2=0%). This study suggests that there was no association between treatment with RAAS inhibitors and worsened COVID-19 disease outcomes. Our findings support the current guidelines that RAAS inhibitors should be continued in the setting of the COVID-19 pandemic. However, the benefit of RAAS inhibitor medications for COVID-19 patients should be further validated with more RCTs.