Background: controversy has arisen in the scientific community on whether the use of renin angiotensin system (RAS) inhibitors in the context of COVID-19 would be of benefit or harmful. A meta-analysis of eligible studies comparing the occurrence of severe and fatal COVID-19 in infected patients who were under treatment with angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) vs no treatment or other antihypertensives was conducted. Methods: PubMed, Google Scholar, the Cochrane Library, MedRxiv and BioRxiv were searched for relevant studies. Fixed-effect models or random-effect models were used depending on the heterogeneity between estimates. Results: a total of fifteen studies with 21,614 patients were included. The use of RAS inhibitors was associated with a non-significant 20% decreased risk of the composite outcome (death, admission to intensive care unit, mechanical ventilation requirement or progression to severe or critical pneumonia): RR 0.81 (95%CI: 0.63-1.04), p=0.10, I2=82%. In a subgroup analysis that included hypertensive subjects only, ACEI/ARB were associated with a 27% significant decrease in the risk of the composite outcome (RR 0.73 (95%CI: 0.56-0.96), p=0.02, I2=65%). Conclusion: the results of this pooled analysis suggest that the use of ACEI/ARB does not worsen the prognosis, and could even be protective in hypertensive subjects. Patients should continue these drugs during their COVID-19 illness.

中文翻译：

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肾素血管紧张素系统抑制剂和COVID-19预后的使用：系统评价和荟萃分析

背景：在科学界已经出现了关于在COVID-19的背景下使用肾素血管紧张素系统（RAS）抑制剂是有益还是有害的争论。对符合条件的研究进行荟萃分析，比较接受血管紧张素转化酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）与未治疗或其他降压药治疗的感染患者中严重和致命COVID-19的发生率。方法：检索PubMed，Google Scholar，Cochrane图书馆，MedRxiv和BioRxiv以进行相关研究。根据估计之间的异质性，使用固定效应模型或随机效应模型。结果：共纳入15项研究，共21,614例患者。RAS抑制剂的使用与综合结局（死亡，重症监护病房，机械通气需求或发展为重症或严重肺炎）的风险显着降低20％无关：RR 0.81（95％CI：0.63-） 1.04），p = 0.10，I2 = 82％。在仅包括高血压受试者的亚组分析中，ACEI / ARB与综合结局风险显着降低27％相关（RR 0.73（95％CI：0.56-0.96），p = 0.02，I2 = 65％） 。结论：汇总分析结果表明ACEI / ARB的使用不会使预后恶化，甚至可以对高血压患者起到保护作用。患者在COVID-19疾病期间应继续使用这些药物。81（95％CI：0.63-1.04），p ＝ 0.10，I 2 ＝ 82％。在仅包括高血压受试者的亚组分析中，ACEI / ARB与综合结局风险显着降低27％相关（RR 0.73（95％CI：0.56-0.96），p = 0.02，I2 = 65％） 。结论：汇总分析结果表明ACEI / ARB的使用不会使预后恶化，甚至可以对高血压患者起到保护作用。患者在COVID-19疾病期间应继续使用这些药物。81（95％CI：0.63-1.04），p ＝ 0.10，I 2 ＝ 82％。在仅包括高血压受试者的亚组分析中，ACEI / ARB与综合结局风险显着降低27％相关（RR 0.73（95％CI：0.56-0.96），p = 0.02，I2 = 65％） 。结论：汇总分析结果表明ACEI / ARB的使用不会使预后恶化，甚至可以对高血压患者起到保护作用。患者在COVID-19疾病期间应继续使用这些药物。甚至可以对高血压患者起到保护作用。患者在COVID-19疾病期间应继续使用这些药物。甚至可以对高血压患者起到保护作用。患者在COVID-19疾病期间应继续使用这些药物。