Supplemental Digital Content is available in the text. The viral spike coat protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) engages the human ACE (angiotensin-converting enzyme) 2 cell surface receptor to infect the host cells. Thus, concerns arose regarding theoretically higher risk for coronavirus disease-19 (COVID-19) in patients taking ACE inhibitors/angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]). We systematically assessed case-population and cohort studies from MEDLINE (Ovid), Cochrane Database of Systematic Reviews PubMed, Embase, medRXIV, the World Health Organization database of COVID-19 publications, and ClinicalTrials.gov through June 1, 2020, with planned ongoing surveillance. We rated the certainty of evidence according to Cochrane methods and the Grading of Recommendations Assessment, Development and Evaluation approach. After pooling the adjusted odds ratios from the included studies, no significant increase was noted in the risk of SARS-CoV-2 infection by the use of ACE inhibitors (adjusted odds ratio, 0.95 [95% CI, 0.86–1.05]) or ARBs (adjusted odds ratio, 1.05 [95% CI, 0.97–1.14]). However, the random-effects meta-regression revealed that age may modify the SARS-CoV-2 infection risk in subjects with the use of ARBs (coefficient, −0.006 [95% CI, −0.016 to 0.004]), that is, the use of ARBs, as opposed to ACE inhibitors, specifically augmented the risk of SARS-CoV-2 infection in younger subjects (<60 years old). The use of ACE inhibitors might not increase the susceptibility of SARS-CoV-2 infection, severity of disease, and mortality in case-population and cohort studies. Additionally, we discovered for the first time that the use of ARBs, as opposed to ACE inhibitors, specifically augmented the risk of SARS-CoV-2 infection in younger subjects, without obvious effects on COVID-19 outcomes.

中文翻译：

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肾素-血管紧张素-醛固酮系统抑制剂和 SARS-CoV-2 感染风险：系统评价和荟萃分析

补充数字内容在文本中可用。严重急性呼吸系统综合症冠状病毒 2 (SARS-CoV-2) 的病毒刺突外壳蛋白与人类 ACE（血管紧张素转换酶）2 细胞表面受体结合以感染宿主细胞。因此，人们担心理论上服用 ACE 抑制剂/血管紧张素 II 1 型受体拮抗剂（血管紧张素受体阻滞剂 [ARBs]）的患者患冠状病毒病 19（COVID-19）的风险更高。我们系统地评估了来自 MEDLINE (Ovid)、Cochrane 系统评价数据库 PubMed、Embase、medRXIV、世界卫生组织 COVID-19 出版物数据库和 ClinicalTrials.gov 的病例人群和队列研究，直至 2020 年 6 月 1 日，并计划进行中监视。我们根据 Cochrane 方法和推荐分级评估、制定和评估方法对证据的确定性进行评级。汇总纳入研究的调整后的优势比后，未发现使用 ACE 抑制剂（调整后的优势比，0.95 [95% CI，0.86–1.05]）或 ARB 会显着增加感染 SARS-CoV-2 的风险（调整后的优势比，1.05 [95% CI，0.97–1.14]）。然而，随机效应元回归显示，年龄可能会改变使用 ARB 的受试者的 SARS-CoV-2 感染风险（系数，-0.006 [95% CI，-0.016 至 0.004]），即与 ACE 抑制剂相比，使用 ARB 特别增加了年轻受试者（<60 岁）感染 SARS-CoV-2 的风险。使用 ACE 抑制剂可能不会增加 SARS-CoV-2 感染的易感性，病例人群和队列研究中疾病的严重程度和死亡率。此外，我们首次发现使用 ARB 与 ACE 抑制剂相比，特别增加了年轻受试者感染 SARS-CoV-2 的风险，而对 COVID-19 结果没有明显影响。