may 2020 • Pharmacological Research

ACEI/ARB Use and Risk of Infection or Severity or Mortality of COVID-19: A Systematic Review and Meta-analysis

Xue Zhang, Jiong Yu, Li-ya Pan, Hai-yin Jiang

DOI: 10.1016/j.phrs.2020.104927

Content curation::David Rodrigues

Key message

Meta-análise de estudos observacionais que não confirma preocupações anteriores sobre um risco maior de infecção, maior gravidade e mortalidade em pacientes com COVID-19 que fazem IECA ou ARA. Pelo contrário, um menor risco de mortalidade foi observado quando limitando análise a pacientes com hipertensão (análise com elevado risco de viés). Parece-nos no entando seguro afirmar que os doentes não devem descontinuar estes fármacos.


We have sparse knowledge of the effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) on the risk of COVID-19 infection and the progression of this disease. We systematically assessed these relationships. Unrestricted searches of the PubMed, Embase, and Cochrane Library databases were conducted, with an end date of May 9, 2020, to identify relevant studies that met predetermined inclusion criteria. Random-effects models were adopted to estimate the overall relative risk. Fourteen articles involving more than 19000 COVID-19 cases were included. Our results showed that ACEI/ARB exposure is not associated with a higher risk of COVID-19 infection (OR = 0.99; 95% CI, 0.95-1.04; P = 0.672). Among those with COVID-19 infection, ACEI/ARB exposure is not associated with a higher risk of severity (OR = 0.98; 95%CI 0.87-1.09; P = 0.69) or mortality (OR = 0.73, 95%CI 0.5-1.07; P = 0.111). However, ACEI/ARB exposure was associated with a lower risk of mortality compared those with non-ACEI/ARB antihypertensive drugs (OR = 0.48, 95% CI 0.29-0.81; P = 0.006). In conclusion, current evidence did not confirm previous concern regarding a harmful role of ACEI/ARB in COVID-19 patients. The present study support current professional society guidelines to not discontinue ACEIs or ARBs in the setting of the COVID-19 pandemic or COVID-19 patients.