Background: Patients with cardiovascular disease are at increased risk of critical illness and mortality from Covid-19 disease. Conflicting findings have raised concerns regarding the association of angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs) use with likelihood or severity of infection during this pandemic. Objective: To study the cumulative evidence for association of ACEI/ARB use with outcomes among patients with confirmed Covid-19. Methods: The MEDLINE and EMBASE databases were thoroughly searched from November 01, 2019 to May 15, 2020 for studies reporting on outcomes based on ACEI/ARB use in patients with confirmed Covid-19. Preferred reporting items for systematic review and meta-analysis guidelines were used for the present study. Relevant data was collected and pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using random-effects model. Main Outcome measures: In-hospital mortality was the primary end of interest. Second end-point was severe or critical illness defined as either need for intensive care unit, invasive mechanical ventilation, or mortality. Results: Fifteen studies with total of 23,822 patients (N ACEI/ARB=6,650) were included in the present analysis. Overall, prevalence of ACEI/ARB use ranged from 7.7% to 46.2% across studies. Among 10 studies, patients using ACEI/ARB had similar odds of mortality [OR 1.03 (0.69-1.55)] and severe or critical illness [1.18 (0.91-1.54)] compared to those not on ACEI/ARB. In an analysis restricted to patients with hypertension, ACEI/ARB use was associated with significantly lower mortality [0.64 (0.45-0.89)], while the odds of severe/critical illness [0.76(0.52-1.12); p=0.16] remained non-significant compared with non-ACEI/ARB users. Conclusion: There is no evidence for increased risk of severe illness or mortality in patients using ACEI/ARB compared with non-users. In patients with hypertension, ACE/ARB use might be associated with reduced mortality, however these findings need to be confirmed in prospective randomized controlled trials.

中文翻译：

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肾素血管紧张素系统阻滞剂与Covid-19患者预后的关联：系统评价和荟萃分析

背景：患有心血管疾病的患者因Covid-19疾病而患严重疾病和死亡的风险增加。矛盾的发现引起了人们的担忧，即在这种大流行期间，血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）的使用与感染的可能性或严重性有关。目的：研究确诊Covid-19的患者中ACEI / ARB使用与预后相关的累积证据。方法：从2019年11月1日至2020年5月15日对MEDLINE和EMBASE数据库进行彻底搜索，以研究报告基于确诊Covid-19的患者使用ACEI / ARB的结果的研究。本研究使用系统评价和荟萃分析指南的首选报告项目。收集相关数据，并使用随机效应模型计算95％置信区间（CI）的合并比值比（OR）。主要结果指标：院内死亡率是主要关注目标。第二个终点是严重或严重疾病，定义为需要加护病房，有创机械通气或死亡率。结果：本研究包括15项研究，总计23,822例患者（N ACEI / ARB = 6,650）。总体而言，ACEI / ARB的使用率在整个研究中介于7.7％至46.2％之间。在10项研究中，使用ACEI / ARB的患者与未使用ACEI / ARB的患者相比，死亡率[OR 1.03（0.69-1.55）]和严重或重症[1.18（0.91-1.54）]相似。在一项仅限于高血压患者的分析中，ACEI / ARB的使用显着降低了死亡率[0.64（0。45-0.89）]，而严重/重症的几率[0.76（0.52-1.12）; p = 0.16]与非ACEI / ARB用户相比仍然不显着。结论：与非使用者相比，没有证据表明使用ACEI / ARB的患者发生严重疾病或死亡的风险增加。在高血压患者中，使用ACE / ARB可能会降低死亡率，但是这些发现需要在前瞻性随机对照试验中得到证实。