Prognostic Impact Of ACEI/ARB On COVID-19:A Meta-analysis Of Randomized Controlled Trials

Background:The use of angiotensin-converting enzyme inhibitors(ACEI)or angiotensin receptor blockers(ARB)has been widely controversial since the outbreak of COVID-19.We conducted a meta-analysis of eligible randomized controlled trials to compare the prognosis of COVID-19 patients taking ACEI/ARB drugs with those not taking ACEI/ARB drugs to provide new evidence-based medical evidence.Methods:Relevant research literature published in English was searched in Embase,Pub Med,Web of Science,Cochrane Library database and med Rxiv.Eight papers were finally screened according to the inclusion and exclusion criteria.All papers were independently screened and data extracted by two researchers,and relevant data were extracted according to whether ACEI/ARB was taken or not.Review Manager 5.3 was applied to perform statistical analysis and heterogeneity tests on the collected data,and fixed-effects models were used to combine statistics according to the heterogeneity between estimates.Results:A total of 8 randomized controlled tests(RCTs)were included in this metaanalysis,including 767 COVID-19 patients taking ACEI/ARB drugs and 786COVID-19 patients not taking these drugs.The results of the meta-analysis showed that all 8 literatures examined the association between taking ACEI/ARB and mortality in COVID-19 patients,with no difference in mortality between the experimental and control groups(OR : 0.88(0.60-1.26),P=0.51).7 literatures explored the association between the administration of ACEI/ARB drugs and ICU admissions in patients with COVID-19 and showed that the presence or absence of ACEI/ARB drugs did not affect ICU admissions in patients with COVID-19(OR:0.94(0.66-1.35),P = 0.75).In addition,6 literatures statistically correlated ACEI/ARB medications with the use of mechanical ventilation in patients with COVID-19 and showed that ACEI/ARB medications were not associated with the use of mechanical ventilation in patients with COVID-19(OR:1.0(0.72-1.42),P =0.99).This meta-analysis also combined statistics on whether taking ACEI/ARB drugs affected mortality in patients with COVID-19 combined with hypertension in4 literatures,showing that taking ACEI/ARB drugs did not affect mortality in patients with COVID-19 combined with hypertension(OR:0.98(0.56-1.71),P =0.94).Finally 3 literatures explored whether taking ARB drugs improved the prognosis of patients with COVID-19 and showed that ARB drugs had no effect on mortality in patients with COVID-19(OR:0.93(0.43-1.99),P = 0.85).Conclusion:This meta-analysis showed that there was no significant difference in the prognosis of COVID-19 patients in terms of mortality,ICU admission and use of mechanical ventilation with or without ACEI/ARB.The prognosis of COVID-19 patients with combined hypertension was not affected by ACEI/ARB medication,and the therapeutic effect of ARB medication in COVID-19 patients was not captured in this meta-analysis and more large randomized controlled trials are needed to confirm this.Discontinuation of ACEI/ARB drugs is not recommended due to their protective effect on the cardiovascular system.