Title : Role of ACE inhibitors in COVID-19 patients with hypertension
Abstract:
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV2) causes coronavirus disease (COVID-19), a potentially fatal disease that is of immense global public health concern. Angiotensin-Converting Enzyme Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs) share their target receptor site with the SARS-CoV-2 virus, that may cause ACE2 receptor up-regulation which raised concerns regarding ACEI and ARB use in COVID-19 patients. However, many medical professional societies recommended their continued use given the paucity of clinical evidence, but there is a need for a systematic review and meta-analysis of the latest clinical studies. A search was conducted on PubMed, Google Scholar, EMBASE, and various preprint servers for studies comparing clinical outcomes and mortality in COVID-19 patients on ACEIs and/or ARBs, and a meta-analysis was performed. A total of 16 studies were included for the review and meta-analysis. There were conflicting findings reported in the rates of severity and mortality in several studies. In a pooled analysis of four studies, there was a statistically non-significant association of ACEI/ARB use with lower odds of developing severe disease vs. non-users [odds ratio (OR)=0.81, 95% confidence interval (CI): 0.41-1.58, I2=50.52, P-value=0.53). In a pooled analysis of six studies, there was a statistically non-significant association of ACEI/ARB use with lower odds of mortality as compared with non-users (P-value=0.55). Several hypotheses have been put forward explaining the positive and negative aspects of ACEI/ARB administration in COVID-19 patients. Positive effects include ACE2 receptor blockade, disabling viral entry into the heart and lungs, and an overall decrease in inflammation secondary to ACEIs/ARBs, suggesting that the use of an ACEI might be protective against respiratory complications. Negative effects include a possible retrograde feedback mechanism, by which ACE2 receptors are up regulated, which may lead to severe pneumonia, increasing the risk of severe outcomes and mortality. It is concluded that ACEIs and ARBs should be continued in COVID-19 patients.
