Effects of renin–angiotensin system blockers on outcomes from COVID-19: a systematic review and meta-analysis of randomized controlled trials
Authors' conclusion
Conversely, initiation of RAS blockers may be harmful in critically ill patients.
Study context
- Population
- Adults with COVID-19
- Participants
- 3,492 adults16 randomized controlled trials (RCTs)
- Comparison
- ACEi/ARB treatment vs no treatment
- Outcome
- All-cause death
Methodological detailsfixed-effects
- Fixed-effects
Pooled result
As reported in the abstract
Relative risk (CI)
Continuationvs Discontinuation
1.24(0.80–1.92)
Initiationvs No treatment
1.22(0.96–1.55)
Further pooled results
| Outcome | RR (CI) | |
|---|---|---|
| ICU admission, ventilation (continuation)Continuationvs DiscontinuationICU | 0.96 (0.66–1.41) | |
| ICU admission, ventilation (continuation)Continuationvs DiscontinuationVentilation | 0.77 (0.55–1.09) | |
| ICU admission, ventilation (initiation)Initiationvs No treatmentICU | 0.71 (0.47–1.08) | |
| ICU admission, ventilation (initiation)Initiationvs No treatmentVentilation | 1.12 (0.91–1.38) | |
| All-cause death, severe/critical COVID-19 (subgroup)Initiationvs No treatmentIncreased risk | 1.31 (1.01–1.72) | |
| 0.512Relative risk (log scale) |
Safety
| Outcome | RR (CI) | |
|---|---|---|
| Vasopressors, AKI, RRT, thromboembolic events (continuation)Continuationvs DiscontinuationVasopressors | 0.92 (0.58–1.44) | |
| Vasopressors, AKI, RRT, thromboembolic events (continuation)Continuationvs DiscontinuationAKI | 1.01 (0.40–2.56) | |
| Vasopressors, AKI, RRT, thromboembolic events (continuation)Continuationvs DiscontinuationRRT | 1.01 (0.46–2.21) | |
| Vasopressors, AKI, RRT, thromboembolic events (continuation)Continuationvs DiscontinuationThromboembolic events | 1.07 (0.36–3.19) | |
| Vasopressors, AKI, RRT, thromboembolic events (initiation)Initiationvs No treatmentVasopressor use increased | 1.27 (1.02–1.57) | |
| Vasopressors, AKI, RRT, thromboembolic events (initiation)Initiationvs No treatmentAKI | 1.28 (0.89–1.86) | |
| Vasopressors, AKI, RRT, thromboembolic events (initiation)Initiationvs No treatmentRRT | 1.66 (0.89–3.12) | |
| Vasopressors, AKI, RRT, thromboembolic events (initiation)Initiationvs No treatmentThromboembolic events | 1.20 (0.06–23.70) | |
| 0.050.21520Relative risk (log scale) |
Original publication
Effects of renin–angiotensin system blockers on outcomes from COVID-19: a systematic review and meta-analysis of randomized controlled trials. Eur Heart J Cardiovasc Pharmacother. Published 22 September 2023. doi:10.
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