Cargando…
Renin‐Angiotensin System Inhibitors in Patients With COVID‐19: A Meta‐Analysis of Randomized Controlled Trials Led by the International Society of Hypertension
BACKGROUND: Published randomized controlled trials are underpowered for binary clinical end points to assess the safety and efficacy of renin‐angiotensin system inhibitors (RASi) in adults with COVID‐19. We therefore performed a meta‐analysis to assess the safety and efficacy of RASi in adults with...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9496439/ https://www.ncbi.nlm.nih.gov/pubmed/36000426 http://dx.doi.org/10.1161/JAHA.122.026143 |
_version_ | 1784794269399121920 |
---|---|
author | Gnanenthiran, Sonali R. Borghi, Claudio Burger, Dylan Caramelli, Bruno Charchar, Fadi Chirinos, Julio A. Cohen, Jordana B. Cremer, Antoine Di Tanna, Gian Luca Duvignaud, Alexandre Freilich, Daniel Gommans, D. H. Frank Gracia‐Ramos, Abraham E. Murray, Thomas A. Pelorosso, Facundo Poulter, Neil R. Puskarich, Michael A. Rizas, Konstantinos D. Rothlin, Rodolfo Schlaich, Markus P. Schreinlecher, Michael Steckelings, Ulrike Muscha Sharma, Abhinav Stergiou, George S. Tignanelli, Christopher J. Tomaszewski, Maciej Unger, Thomas van Kimmenade, Roland R. J. Wainford, Richard D. Williams, Bryan Rodgers, Anthony Schutte, Aletta E. |
author_facet | Gnanenthiran, Sonali R. Borghi, Claudio Burger, Dylan Caramelli, Bruno Charchar, Fadi Chirinos, Julio A. Cohen, Jordana B. Cremer, Antoine Di Tanna, Gian Luca Duvignaud, Alexandre Freilich, Daniel Gommans, D. H. Frank Gracia‐Ramos, Abraham E. Murray, Thomas A. Pelorosso, Facundo Poulter, Neil R. Puskarich, Michael A. Rizas, Konstantinos D. Rothlin, Rodolfo Schlaich, Markus P. Schreinlecher, Michael Steckelings, Ulrike Muscha Sharma, Abhinav Stergiou, George S. Tignanelli, Christopher J. Tomaszewski, Maciej Unger, Thomas van Kimmenade, Roland R. J. Wainford, Richard D. Williams, Bryan Rodgers, Anthony Schutte, Aletta E. |
author_sort | Gnanenthiran, Sonali R. |
collection | PubMed |
description | BACKGROUND: Published randomized controlled trials are underpowered for binary clinical end points to assess the safety and efficacy of renin‐angiotensin system inhibitors (RASi) in adults with COVID‐19. We therefore performed a meta‐analysis to assess the safety and efficacy of RASi in adults with COVID‐19. METHODS AND RESULTS: MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Controlled Trial Register were searched for randomized controlled trials that randomly assigned patients with COVID‐19 to RASi continuation/commencement versus no RASi therapy. The primary outcome was all‐cause mortality at ≤30 days. A total of 14 randomized controlled trials met the inclusion criteria and enrolled 1838 participants (aged 59 years, 58% men, mean follow‐up 26 days). Of the trials, 11 contributed data. We found no effect of RASi versus control on all‐cause mortality (7.2% versus 7.5%; relative risk [RR], 0.95; [95% CI, 0.69–1.30]) either overall or in subgroups defined by COVID‐19 severity or trial type. Network meta‐analysis identified no difference between angiotensin‐converting enzyme inhibitors versus angiotensin II receptor blockers. RASi users had a nonsignificant reduction in acute myocardial infarction (2.1% versus 3.6%; RR, 0.59; [95% CI, 0.33–1.06]), but increased risk of acute kidney injury (7.0% versus 3.6%; RR, 1.82; [95% CI, 1.05–3.16]), in trials that initiated and continued RASi. There was no increase in need for dialysis or differences in congestive cardiac failure, cerebrovascular events, venous thromboembolism, hospitalization, intensive care admission, inotropes, or mechanical ventilation. CONCLUSIONS: This meta‐analysis of randomized controlled trials evaluating angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers versus control in patients with COVID‐19 found no difference in all‐cause mortality, a borderline decrease in myocardial infarction, and an increased risk of acute kidney injury with RASi. Our findings provide strong evidence that RASi can be used safely in patients with COVID‐19. |
format | Online Article Text |
id | pubmed-9496439 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-94964392022-09-30 Renin‐Angiotensin System Inhibitors in Patients With COVID‐19: A Meta‐Analysis of Randomized Controlled Trials Led by the International Society of Hypertension Gnanenthiran, Sonali R. Borghi, Claudio Burger, Dylan Caramelli, Bruno Charchar, Fadi Chirinos, Julio A. Cohen, Jordana B. Cremer, Antoine Di Tanna, Gian Luca Duvignaud, Alexandre Freilich, Daniel Gommans, D. H. Frank Gracia‐Ramos, Abraham E. Murray, Thomas A. Pelorosso, Facundo Poulter, Neil R. Puskarich, Michael A. Rizas, Konstantinos D. Rothlin, Rodolfo Schlaich, Markus P. Schreinlecher, Michael Steckelings, Ulrike Muscha Sharma, Abhinav Stergiou, George S. Tignanelli, Christopher J. Tomaszewski, Maciej Unger, Thomas van Kimmenade, Roland R. J. Wainford, Richard D. Williams, Bryan Rodgers, Anthony Schutte, Aletta E. J Am Heart Assoc Systematic Review and Meta‐analysis BACKGROUND: Published randomized controlled trials are underpowered for binary clinical end points to assess the safety and efficacy of renin‐angiotensin system inhibitors (RASi) in adults with COVID‐19. We therefore performed a meta‐analysis to assess the safety and efficacy of RASi in adults with COVID‐19. METHODS AND RESULTS: MEDLINE, EMBASE, ClinicalTrials.gov, and the Cochrane Controlled Trial Register were searched for randomized controlled trials that randomly assigned patients with COVID‐19 to RASi continuation/commencement versus no RASi therapy. The primary outcome was all‐cause mortality at ≤30 days. A total of 14 randomized controlled trials met the inclusion criteria and enrolled 1838 participants (aged 59 years, 58% men, mean follow‐up 26 days). Of the trials, 11 contributed data. We found no effect of RASi versus control on all‐cause mortality (7.2% versus 7.5%; relative risk [RR], 0.95; [95% CI, 0.69–1.30]) either overall or in subgroups defined by COVID‐19 severity or trial type. Network meta‐analysis identified no difference between angiotensin‐converting enzyme inhibitors versus angiotensin II receptor blockers. RASi users had a nonsignificant reduction in acute myocardial infarction (2.1% versus 3.6%; RR, 0.59; [95% CI, 0.33–1.06]), but increased risk of acute kidney injury (7.0% versus 3.6%; RR, 1.82; [95% CI, 1.05–3.16]), in trials that initiated and continued RASi. There was no increase in need for dialysis or differences in congestive cardiac failure, cerebrovascular events, venous thromboembolism, hospitalization, intensive care admission, inotropes, or mechanical ventilation. CONCLUSIONS: This meta‐analysis of randomized controlled trials evaluating angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers versus control in patients with COVID‐19 found no difference in all‐cause mortality, a borderline decrease in myocardial infarction, and an increased risk of acute kidney injury with RASi. Our findings provide strong evidence that RASi can be used safely in patients with COVID‐19. John Wiley and Sons Inc. 2022-08-24 /pmc/articles/PMC9496439/ /pubmed/36000426 http://dx.doi.org/10.1161/JAHA.122.026143 Text en © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Systematic Review and Meta‐analysis Gnanenthiran, Sonali R. Borghi, Claudio Burger, Dylan Caramelli, Bruno Charchar, Fadi Chirinos, Julio A. Cohen, Jordana B. Cremer, Antoine Di Tanna, Gian Luca Duvignaud, Alexandre Freilich, Daniel Gommans, D. H. Frank Gracia‐Ramos, Abraham E. Murray, Thomas A. Pelorosso, Facundo Poulter, Neil R. Puskarich, Michael A. Rizas, Konstantinos D. Rothlin, Rodolfo Schlaich, Markus P. Schreinlecher, Michael Steckelings, Ulrike Muscha Sharma, Abhinav Stergiou, George S. Tignanelli, Christopher J. Tomaszewski, Maciej Unger, Thomas van Kimmenade, Roland R. J. Wainford, Richard D. Williams, Bryan Rodgers, Anthony Schutte, Aletta E. Renin‐Angiotensin System Inhibitors in Patients With COVID‐19: A Meta‐Analysis of Randomized Controlled Trials Led by the International Society of Hypertension |
title | Renin‐Angiotensin System Inhibitors in Patients With COVID‐19: A Meta‐Analysis of Randomized Controlled Trials Led by the International Society of Hypertension |
title_full | Renin‐Angiotensin System Inhibitors in Patients With COVID‐19: A Meta‐Analysis of Randomized Controlled Trials Led by the International Society of Hypertension |
title_fullStr | Renin‐Angiotensin System Inhibitors in Patients With COVID‐19: A Meta‐Analysis of Randomized Controlled Trials Led by the International Society of Hypertension |
title_full_unstemmed | Renin‐Angiotensin System Inhibitors in Patients With COVID‐19: A Meta‐Analysis of Randomized Controlled Trials Led by the International Society of Hypertension |
title_short | Renin‐Angiotensin System Inhibitors in Patients With COVID‐19: A Meta‐Analysis of Randomized Controlled Trials Led by the International Society of Hypertension |
title_sort | renin‐angiotensin system inhibitors in patients with covid‐19: a meta‐analysis of randomized controlled trials led by the international society of hypertension |
topic | Systematic Review and Meta‐analysis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9496439/ https://www.ncbi.nlm.nih.gov/pubmed/36000426 http://dx.doi.org/10.1161/JAHA.122.026143 |
work_keys_str_mv | AT gnanenthiransonalir reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT borghiclaudio reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT burgerdylan reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT caramellibruno reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT charcharfadi reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT chirinosjulioa reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT cohenjordanab reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT cremerantoine reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT ditannagianluca reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT duvignaudalexandre reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT freilichdaniel reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT gommansdhfrank reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT graciaramosabrahame reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT murraythomasa reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT pelorossofacundo reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT poulterneilr reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT puskarichmichaela reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT rizaskonstantinosd reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT rothlinrodolfo reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT schlaichmarkusp reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT schreinlechermichael reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT steckelingsulrikemuscha reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT sharmaabhinav reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT stergiougeorges reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT tignanellichristopherj reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT tomaszewskimaciej reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT ungerthomas reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT vankimmenaderolandrj reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT wainfordrichardd reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT williamsbryan reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT rodgersanthony reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT schuttealettae reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension AT reninangiotensinsysteminhibitorsinpatientswithcovid19ametaanalysisofrandomizedcontrolledtrialsledbytheinternationalsocietyofhypertension |