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Comparison of renin–angiotensin–aldosterone system inhibitors with other antihypertensives in association with coronavirus disease-19 clinical outcomes


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Bezabih, YM, Bezabih, A, Alamneh, E, Peterson, GM ORCID: 0000-0002-6764-3882 and Bezabhe, W ORCID: 0000-0002-3028-6949 2021 , 'Comparison of renin–angiotensin–aldosterone system inhibitors with other antihypertensives in association with coronavirus disease-19 clinical outcomes' , BMC Infectious Diseases, vol. 21 , pp. 1-11 , doi: 10.1186/s12879-021-06088-6.

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Background: Reports on the effects of renin–angiotensin–aldosterone system (RAAS) inhibitors on the clinicaloutcomes of coronavirus disease-19 (COVID-19) have been conflicting. We performed this meta-analysis to findconclusive evidence.Methods: We searched published articles through PubMed, EMBASE and medRxiv from 5 January 2020 to 3 August2020. Studies that reported clinical outcomes of patients with COVID-19, stratified by the class of antihypertensives,were included. Random and fixed-effects models were used to estimate pooled odds ratio (OR).Results: A total 36 studies involving 30,795 patients with COVID-19 were included. The overall risk of poor patientoutcomes (severe COVID-19 or death) was lower in patients taking RAAS inhibitors (OR = 0.79, 95% CI: [0.67, 0.95])compared with those receiving non-RAAS inhibitor antihypertensives. However, further sub-meta-analysis showedthat specific RAAS inhibitors did not show a reduction of poor COVID-19 outcomes when compared with any classof antihypertensive except beta-blockers (BBs). For example, compared to calcium channel blockers (CCBs), neitherangiotensin-I-converting enzyme inhibitors (ACEIs) (OR = 0.91, 95% CI: [0.67, 1.23]) nor angiotensin-II receptorblockers (ARBs) (OR = 0.90, 95% CI: [0.62, 1.33]) showed a reduction of poor COVID-19 outcomes. When comparedwith BBs, however, both ACEIs (OR = 0.85, 95% CI: [0.73, 0.99) and ARBs (OR = 0.72, 95% CI: [0.55, 0.94]) showed anapparent decrease in poor COVID-19 outcomes.Conclusions: RAAS inhibitors did not increase the risk of mortality or severity of COVID-19. Differences in COVID-19clinical outcomes between different class of antihypertensive drugs were likely due to the underlying comorbiditiesfor which the antihypertensive drugs were prescribed, although adverse effects of drugs such as BBs could not beexcluded.

Item Type: Article
Authors/Creators:Bezabih, YM and Bezabih, A and Alamneh, E and Peterson, GM and Bezabhe, W
Keywords: RAAS inhibitors, COVID-19, coronavirus, angiotensin, clinical outcome, ACE2
Journal or Publication Title: BMC Infectious Diseases
Publisher: Biomed Central Ltd
ISSN: 1471-2334
DOI / ID Number: 10.1186/s12879-021-06088-6
Copyright Information:

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) License, ( which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

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