Treatment with ACE inhibitors or ARBs and risk of severe/lethal COVID-19: a meta-analysis
Treatment with ACE inhibitors or ARBs and risk of severe/lethal COVID-19: a meta-analysis
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DOI：
10.1136/heartjnl-2020-317336
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发表时间：
2020-10-01
期刊：
影响因子：
5.7
通讯作者：
Manzoli, Lamberto
中科院分区：
文献类型：
--
作者：
Flacco, Maria Elena;Martellucci, Cecilia Acuti;Manzoli, Lamberto
目的血管紧张素转换酶抑制剂和血管紧张素受体拮抗剂(ARB)的使用可能增加或降低严重或致命性新冠肺炎的风险。现有的观察性研究的结果各不相同，迫切需要简要的估计来阐明这些药物是否应该在大流行期间暂停使用，或者是否应该肯定地让患者和医生放心。这项对调整后的观察数据的荟萃分析旨在总结关于这些药物与严重/致命性COVID-19之间相关性的现有证据。方法我们检索了截至2020年6月8日的Medline、SCOPUS和Preprint资料库，检索队列或病例对照研究，比较接受(1)血管紧张素转换酶抑制剂、(2)ARBS和(3)两者的高血压患者与未治疗的高血压患者发生严重/致命新冠肺炎(无论是机械通气、重症监护病房入院还是死亡)的风险。结果10项研究共纳入9890名高血压受试者。与未经治疗的受试者相比，使用血管紧张素转换酶抑制剂或ARBS的患者发生严重或致命新冠肺炎的风险相似(汇总OR：0.9；血管紧张素转换酶抑制剂的95%可信区间0.65至1.26；血管紧张素转换酶抑制剂的95%可信区间0.75至1.12)。当两种药物一起考虑时，结果没有改变，死亡是结果，排除了有显著差异的结果的研究。结论目前的荟萃分析强烈支持几个科学协会的建议，对所有患者继续使用ARB或ACE抑制剂，除非他们的医生另有建议，因此应该得到保证。
Objective It has been hypothesised that the use of ACE inhibitors and angiotensin receptor blockers (ARBs) might either increase or reduce the risk of severe or lethal COVID-19. The findings from the available observational studies varied, and summary estimates are urgently needed to elucidate whether these drugs should be suspended during the pandemic, or patients and physicians should be definitely reassured. This meta-analysis of adjusted observational data aimed to summarise the existing evidence on the association between these medications and severe/lethal COVID-19.Methods We searched MedLine, Scopus and preprint repositories up to 8 June 2020 to retrieve cohort or case-control studies comparing the risk of severe/fatal COVID-19 (either mechanical ventilation, intensive care unit admission or death), among hypertensive subjects treated with: (1) ACE inhibitors, (2) ARBs and (3) both, versus untreated subjects. Data were combined using a random-effect generic inverse variance approach.Results Ten studies, enrolling 9890 hypertensive subjects were included in the analyses. Compared with untreated subjects, those using either ACE inhibitors or ARBs showed a similar risk of severe or lethal COVID-19 (summary OR: 0.90; 95% CI 0.65 to 1.26 for ACE inhibitors; 0.92; 95% CI 0.75 to 1.12 for ARBs). The results did not change when both drugs were considered together, when death was the outcome and excluding the studies with significant, divergent results.Conclusion The present meta-analysis strongly supports the recommendation of several scientific societies to continue ARBs or ACE inhibitors for all patients, unless otherwise advised by their physicians who should thus be reassured.