Comparison of infection risks and clinical outcomes in patients with and without SARS-CoV-2 lung infection under renin-angiotensin-aldosterone system blockade: Systematic review and meta-analysis.
ACE inhibitors
ACE2
SARS-CoV-2
angiotensin II receptor blockers
Journal
British journal of clinical pharmacology
ISSN: 1365-2125
Titre abrégé: Br J Clin Pharmacol
Pays: England
ID NLM: 7503323
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
revised:
28
10
2020
received:
15
06
2020
accepted:
10
11
2020
pubmed:
21
11
2020
medline:
25
6
2021
entrez:
20
11
2020
Statut:
ppublish
Résumé
Angiotensin-converting enzyme-2 (ACE2) is the receptor for SARS-CoV-2. Animal studies suggest that renin-angiotensin-aldosterone system (RAAS) blockers might increase the expression of ACE2 and potentially increase the risk of SARS-CoV-2 infection. The effect of ACE inhibitor (ACEI) treatment on the pneumonia incidence in non-COVID-19 patients (25 studies, 330 780 patients) was associated with a 26% reduction of pneumonia risk (odds ratio [OR]: 0.74, P < .001). Pneumonia-related death cases in ACEI-treated non-COVID-19 patients were reduced by 27% (OR: 0.73, P = .004). However, angiotensin II receptor blockers (ARB) treatment (10 studies, 275 621 non-COVID-19 patients) did not alter pneumonia risk in patients. Pneumonia-related death cases in ARB-treated non-COVID-19 patients was analysed only in 1 study and was significantly reduced (OR, 0.47; 95% confidence interval, 0.30 to 0.72). Results from 11 studies (8.4 million patients) showed that the risk of getting infected with the SARS-CoV-2 virus was reduced by 13% (OR: 0.87, P = .014) in patients treated with ACEI, whereas analysis from 10 studies (8.4 million patients) treated with ARBs showed no effect (OR, 0.92, P = .354). Results from 34 studies in 67 644 COVID-19 patients showed that RAAS blockade reduces all-cause mortality by 24% (OR = 0.76, P = .04). ACEIs reduce the risk of getting infected with the SARS-CoV-2 virus. Blocking the RAAS may decrease all-cause mortality in COVID-19 patients. ACEIs also reduce the risk of non-COVID pneumonia. All-cause mortality due to non-COVID pneumonia is reduced by ACEI and potentially by ARBs.
Identifiants
pubmed: 33217033
doi: 10.1111/bcp.14660
pmc: PMC7753617
doi:
Substances chimiques
Angiotensin Receptor Antagonists
0
Angiotensin-Converting Enzyme Inhibitors
0
Types de publication
Journal Article
Meta-Analysis
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
2475-2492Informations de copyright
© 2020 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.
Références
Semin Respir Crit Care Med. 2013 Aug;34(4):475-86
pubmed: 23934716
Arch Intern Med. 2002 May 13;162(9):1059-64
pubmed: 11996618
JAMA Cardiol. 2020 Sep 1;5(9):1020-1026
pubmed: 32936273
Am J Hypertens. 2020 Oct 21;33(10):944-948
pubmed: 32511678
Anatol J Cardiol. 2020 Jul;24(1):21-29
pubmed: 32628137
Science. 2020 Mar 13;367(6483):1260-1263
pubmed: 32075877
Am J Epidemiol. 2017 Jun 1;185(11):1174-1183
pubmed: 30052736
Eur Heart J. 2005 Feb;26(4):369-75; discussion 322-4
pubmed: 15671045
Proc (Bayl Univ Med Cent). 2018 Oct 26;31(4):419-423
pubmed: 30948970
Shock. 2015 Apr;43(4):395-404
pubmed: 25768373
Neurology. 2005 Feb 8;64(3):573-4
pubmed: 15699404
Eur Heart J. 2020 Jun 7;41(22):2058-2066
pubmed: 32498076
Lancet. 2020 May 30;395(10238):1705-1714
pubmed: 32416785
PLoS One. 2014 Oct 29;9(10):e110165
pubmed: 25353172
Cardiovasc Res. 2020 May 1;116(6):1097-1100
pubmed: 32227090
Crit Care Med. 2012 Feb;40(2):587-93
pubmed: 21946655
J Am Heart Assoc. 2020 Nov 3;9(21):e017736
pubmed: 32807002
Front Microbiol. 2013 Sep 12;4:278
pubmed: 24062735
Kidney Int. 2020 Aug;98(2):314-322
pubmed: 32461141
J Am Med Dir Assoc. 2020 Jul;21(7):909-914.e2
pubmed: 32674818
Eur Heart J. 2009 May;30(10):1203-12
pubmed: 19346521
Clin Exp Hypertens. 2020 Nov 16;42(8):738-742
pubmed: 32569491
N Engl J Med. 2020 Jun 18;382(25):2441-2448
pubmed: 32356628
J Am Coll Cardiol. 2020 Jul 21;76(3):268-276
pubmed: 32470515
JACC Heart Fail. 2017 Jul;5(7):471-482
pubmed: 28662936
JAMA Intern Med. 2020 Oct 1;180(10):1345-1355
pubmed: 32667669
BMJ. 2012 Jul 11;345:e4260
pubmed: 22786934
Pharmacoepidemiol Drug Saf. 2009 Apr;18(4):269-75
pubmed: 19235776
Pharmacoepidemiol Drug Saf. 2009 Aug;18(8):697-703
pubmed: 19455553
J Am Heart Assoc. 2020 Sep;9(17):e016948
pubmed: 32633594
Clin Infect Dis. 2020 Dec 3;71(9):2447-2456
pubmed: 32623470
Clin Infect Dis. 2020 Nov 19;71(16):2121-2128
pubmed: 32442285
J Infect. 2020 Nov;81(5):816-846
pubmed: 32800800
Am J Hypertens. 2005 Oct;18(10):1353-9
pubmed: 16202861
Pharmacol Res. 2017 Nov;125(Pt A):21-38
pubmed: 28619367
J Am Med Dir Assoc. 2015 Aug 1;16(8):702-7
pubmed: 26123256
J Infect Dis. 2020 Sep 14;222(8):1256-1264
pubmed: 32702098
BMJ. 2008 Apr 26;336(7650):924-6
pubmed: 18436948
J Crit Care. 2020 Dec;60:32-37
pubmed: 32736197
J Hypertens. 2010 Feb;28(2):401-5
pubmed: 20051911
Hypertension. 2020 Aug;76(2):e15-e17
pubmed: 32493070
JAMA. 2020 May 26;323(20):2052-2059
pubmed: 32320003
Hypertension. 2020 Sep;76(3):742-749
pubmed: 32654557
Pharmacotherapy. 2006 Apr;26(4):479-82
pubmed: 16553505
Emerg Microbes Infect. 2020 Dec;9(1):757-760
pubmed: 32228222
N Engl J Med. 2020 Jun 18;382(25):2464
pubmed: 32484612
Lancet. 1987 Nov 14;2(8568):1116-8
pubmed: 2890021
Curr Opin Pulm Med. 2017 May;23(3):193-197
pubmed: 28221171
Gastroenterology. 2020 Sep;159(3):1170-1172.e1
pubmed: 32422208
Am J Respir Crit Care Med. 2020 Jun 1;201(11):1380-1388
pubmed: 32275452
Thorax. 1996 Feb;51(2):199-201
pubmed: 8711657
Scott Med J. 2020 Nov;65(4):149-153
pubmed: 32873147
Chest. 2000 Jun;117(6):1819-20
pubmed: 10858427
Eur J Clin Pharmacol. 1995;49(1-2):95-102
pubmed: 8751029
BMC Pulm Med. 2005 Sep 13;5:12
pubmed: 16159398
Am J Hypertens. 1999 Aug;12(8 Pt 1):778-83
pubmed: 10480470
N Engl J Med. 2006 Jan 12;354(2):131-40
pubmed: 16407508
Drug Saf. 2020 Dec;43(12):1297-1308
pubmed: 32852721
Lancet. 2002 Mar 23;359(9311):995-1003
pubmed: 11937178
Front Cardiovasc Med. 2020 Jul 14;7:138
pubmed: 32766285
J Am Geriatr Soc. 2006 Jan;54(1):175-6
pubmed: 16420224
Lancet. 1997 Jun 28;349(9069):1857-63
pubmed: 9217756
Hypertension. 2004 May;43(5):970-6
pubmed: 15007027
Clin Infect Dis. 2020 Nov 19;71(16):2291-2293
pubmed: 32442294
J Hypertens. 2012 Nov;30(11):2223-9
pubmed: 22929610
Korean J Intern Med. 2021 Mar;36(Suppl 1):S114-S122
pubmed: 32872736
N Engl J Med. 2020 Jun 18;382(25):e102
pubmed: 32356626
J Epidemiol. 2013 Sep 5;23(5):344-50
pubmed: 23912052
Chest. 2003 Jul;124(1):328-36
pubmed: 12853541
Am J Med Sci. 2008 Dec;336(6):462-6
pubmed: 19092318
Neurol Sci. 2020 Sep;41(9):2317-2324
pubmed: 32643133
JAMA. 2020 Jul 14;324(2):168-177
pubmed: 32558877
Lancet. 1990 May 19;335(8699):1228-9
pubmed: 1971077
Lancet. 1999 Mar 6;353(9155):843
pubmed: 10459988
JAMA Cardiol. 2020 Jul 1;5(7):825-830
pubmed: 32324209
Stat Med. 2002 Jun 15;21(11):1575-600
pubmed: 12111921
Clin Infect Dis. 2012 Dec;55(11):1466-73
pubmed: 22918991
Front Med. 2020 Oct;14(5):601-612
pubmed: 32621202
BMJ. 2020 Mar 26;368:m1091
pubmed: 32217556
J Am Geriatr Soc. 2004 May;52(5):846-7
pubmed: 15086678
Clin Sci (Lond). 2012 Dec;123(11):649-58
pubmed: 22715807
Heart. 2020 Oct;106(19):1503-1511
pubmed: 32737124
N Engl J Med. 2020 Jun 25;382(26):2582
pubmed: 32501665
PLoS One. 2020 Jun 24;15(6):e0235248
pubmed: 32579597
J Hypertens. 2007 Jan;25(1):235-9
pubmed: 17143196
PLoS One. 2020 Aug 27;15(8):e0238281
pubmed: 32853230
Eur J Heart Fail. 2020 Jun;22(6):967-974
pubmed: 32485082
Circulation. 2005 May 24;111(20):2605-10
pubmed: 15897343
Am J Respir Crit Care Med. 2004 May 1;169(9):1041-5
pubmed: 14990394
J Clin Hypertens (Greenwich). 2020 Aug;22(8):1379-1388
pubmed: 32710674
Hypertension. 2006 Oct;48(4):572-8
pubmed: 16908757
N Engl J Med. 2020 Jun 18;382(25):2431-2440
pubmed: 32356627
Eur Respir J. 2006 Jun;27(6):1217-22
pubmed: 16455828
ESC Heart Fail. 2020 Feb;7(1):25-35
pubmed: 31916413
Hypertension. 2020 Sep;76(3):732-741
pubmed: 32654555
Medicine (Baltimore). 2015 Jul;94(30):e883
pubmed: 26222869
JAMA Cardiol. 2020 Jul 1;5(7):831-840
pubmed: 32219363
BMC Pulm Med. 2017 Jan 11;17(1):12
pubmed: 28077107
Eur Respir J. 2008 Mar;31(3):611-7
pubmed: 17959631
Lancet Respir Med. 2020 Apr;8(4):e21
pubmed: 32171062
Kidney Int. 2020 Jul;98(1):27-34
pubmed: 32437770
Pharmacoepidemiol Drug Saf. 2012 Nov;21(11):1173-82
pubmed: 22949094
Nat Med. 1996 Jul;2(7):814-7
pubmed: 8673930
Ann Transl Med. 2020 Apr;8(7):430
pubmed: 32395474
Am J Phys Med Rehabil. 2009 Jan;88(1):30-8
pubmed: 19096289
Lancet. 1998 Sep 26;352(9133):1069
pubmed: 9759784
J Hypertens. 2020 Dec;38(12):2537-2541
pubmed: 32740406
Clin Ther. 1997 Jul-Aug;19(4):604-16; discussion 603
pubmed: 9377606
Br J Clin Pharmacol. 2021 Jun;87(6):2475-2492
pubmed: 33217033
Am J Med. 2008 Nov;121(11):1002-1007.e1
pubmed: 18954848
J Thorac Oncol. 2020 May;15(5):700-704
pubmed: 32114094
Korean J Intern Med. 2021 Mar;36(Suppl 1):S123-S131
pubmed: 32872731
J Am Geriatr Soc. 2004 Dec;52(12):2010-5
pubmed: 15571535
N Engl J Med. 1995 Dec 21;333(25):1670-6
pubmed: 7477219
Hypertens Res. 2020 Nov;43(11):1257-1266
pubmed: 32820236
Circ Res. 2020 Jun 5;126(12):1671-1681
pubmed: 32302265
Eur Cardiol. 2017 Dec;12(2):76-77
pubmed: 30416556
Stroke. 2005 Jun;36(6):1218-26
pubmed: 15879332
Hypertension. 2020 Jul;76(1):51-58
pubmed: 32348166
Nat Rev Cardiol. 2020 May;17(5):259-260
pubmed: 32139904
J Med Virol. 2020 Jul;92(7):819-823
pubmed: 32232979
N Engl J Med. 2020 Apr 23;382(17):1653-1659
pubmed: 32227760
Am J Cardiol. 2020 Oct 1;132:150-157
pubmed: 32819683
BMJ. 2003 Sep 6;327(7414):557-60
pubmed: 12958120