- Title
- Renin–angiotensin system inhibitor use and the risk of mortality in hospitalized patients with COVID-19: a meta-analysis of randomized controlled trials
- Creator
- Kow, Chia Siang; Ming, Long Chiau; Hasan, Syed Shahzad
- Relation
- Hypertension Research Vol. 44, Issue 8, p. 1042-1045
- Publisher Link
- http://dx.doi.org/10.1038/s41440-021-00670-w
- Publisher
- Nature Publishing Group
- Resource Type
- journal article
- Date
- 2021
- Description
- At the outset of the coronavirus disease 2019 (COVID-19) pandemic, a few researchers [1, 2] postulated that patients with COVID-19 who are receiving renin–angiotensin system (RAS) inhibitors might be at an increased risk for a severe course of illness. This postulation was based on the fact that angiotensin-converting enzyme 2 (ACE2) is the target receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and RAS inhibitors can upregulate the levels of ACE2 and thus facilitate the entry of SARS-CoV-2 into human host cells. Subsequently, advocates proposed the temporary discontinuation of RAS inhibitors in patients with COVID-19 [1, 2]. Nevertheless, we argued that exposure to RAS inhibitors does not consistently lead to the upregulation of the levels of ACE2 and that the ability of RAS inhibitors to upregulate ACE2 is not absolutely deleterious, since, paradoxically, the upregulation of ACE2 might protect against coronavirus-induced acute lung injury [3,4,5]. Therefore, the discontinuation of RAS inhibitors in patients with COVID-19 is controversial, and consideration must be given to whether the established benefits of these agents with regard to cardiovascular diseases and their potential lung-protective properties outweigh their uncertain risks [3, 6,7,8]. Our recent meta-analysis of observational evidence [9] asserted that patients with COVID-19 who used RAS inhibitors had a significantly lower risk of mortality than those who did not use RAS inhibitors. It is likely that residual confounding might have existed in previous observational studies; therefore, further confirmation of such an association is needed in randomized controlled trials. We conducted this meta-analysis of randomized controlled trials to validate the association between the use of RAS inhibitors and mortality in patients with COVID-19.
- Subject
- coronavirus disease; COVID-19; angiotensin; mortality; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1450188
- Identifier
- uon:43854
- Identifier
- ISSN:0916-9636
- Language
- eng
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