Analysis by Place of study Total no. of patients ACEI/ARB group divisions Outcomes
Zhang et al.16
Nine Hospitals in Hubei Province of China
Recruited total of 3611 patients; Among which 3430 patients were selected comprising 1128 were hypertensive and 2302 were normotensive (Hypertensive group had comorbidities like diabetes 21.3%, coronary heart disease 11.6 %, chronic renal disease 3.1%) In the hypertensive group, 188 patients are classified as ACEI/ARB group 940 patients are classified as non-ACEI/ARB group. Statistical analysis showed, ACEI/ARB receiving patients had low risk of COVID-19 mortality than non-ACEI/ARB. (Mixed effect Cox Model: adjusted HR, 0.42; 95% CI, 0.19-0.92; P =0.03; Propensity score matched analysis+ mixed effect Cox model: adjusted HR, 0.37; 95% CI, 0.15-0.89; P = 0.03; Subgroup propensity score-matched analysis: adjusted HR, 0.30; 95% CI, 0.12-0.70; P = 0.01) Incidence of septic shock was 3.2% in ACEI/ARB group than 8.0 % in non-ACEI/ARB group Disseminated intravascular coagulation (DIC) was 0.0 % in ACEI/ARB group than 2.3 % in non-ACEI/ARB group
Bean et al.17
King’s College Hospital and Princess Royal University Hospital, London, UK
The cohort study recruited total of 205 patients (51.2% hypertensive, 30.2% diabetic and 14.6% ischemic heart disease or heart failure)
37 patients on ACEI and 168 patients on non-ACEI 9 patients on ARB and 196 patients on non-ARB
Statistical analysis (NLP: Natural language processing; informatics tools followed by logistic regression applying Firth’s correction) showed ACE inhibitor reduced risk of rapidly deteriorating COVID-19 (OR, 0.29; 95% CI, 0.10-0.75; P < 0.01 in patients with diabetes mellitus, ischemic heart disease, heart failure)
Meng et al.18
Shenzhen Third People’s Hospital, China
The study recruited total of 417 patients in which 51 (12.23 %) were hypertensive. Among which 42 patients met the criteria
Among 42 patients; 17 patients were categorized in ACEI/ARB group 25 patients were non-ACEI/ARB group. The median number of days from the onset of symptoms to hospital admission was 3.0 in the ACEI/ARB group and 2.0 in the non-ACEI/ARB group. ACEI/ARB group of patients had lower IL-6 expression (<20pg/mL) than non-ACEI/ARB group (>20 pg/mL). The peak viral load during hospitalization in the ACEI/ARB group was significantly lower than that in the non-ACEI/ARB group and CD3+ /CD8+ T cells in the ACEI/ARB group was higher than of non-ACEI/ARB group
Yang et al. 19
Hubei Provincial Hospital of Traditional Chinese Medicine, China
Recruited total of 462 patients. (126 patients (27.2% ) had pre-existing hypertension with 30.2% having diabetes, 18.3% having cardiopathy and 125 (27.1%) were normotensive patients Among 126 hypertensive group; 43 patients were sub categorized in ACEI/ARB group 83 patients were non-ACEI/ARB group Hypertensive patients on ACEI/ARB had a much lower proportion of critical patients (9.3% vs 22.9%), and a lower death rate (4.7% vs 13.3%) than those on non-ARBs/ACEIs medications Hypertensive patients on ACEI/ARB had a much lower proportion of critical patients (9.3% vs 22.9%), and a lower death rate (4.7% vs 13.3%) than those on non-ARBs/ACEIs medications
Liu et al.20
1. Shenzhen Third People’s hospital (Shenzhen, China) 2. Renmin Hospital of Wuhan University (Wuhan, China) 3. Fifth Medical Center of People’s Liberation Army General Hospital (Beijing, China) Recruited total of 557 patients. (Among 511 patients, 78 patients had hypertension comorbidity); Additional 46 patients were recruited with age >65 yrs. with premedication history of anti-hypertensive drugs 78 patients were categorized as six sub groups (ACEI, ARB, CCB, BB, thiazide and none); 40 patients were categorized as COVID-19 Mild and 38 patients were categorized as COVID-19 Severe Among 46 patients; 18 were categorized as mild and 28 were categorized as severe. Meta-analysis was performed with 70346 ARB patients associated with pneumonia 78 patients shows no statistical significance in disease severity among six sub groups The risk of 28 patients (COVID-19-severe) was significantly lowered in ARB medication in comparison to patients who took no drugs (OR=0•343, 95% CI 0•128-0•916, p=0•025). ARBs were found to be associated with a declined mortality rate for pneumonia (OR=0•55, 95% CI; 0•44-0•69, p<0•01)