Impact of hospitalised patients with COVID-19 taking Renin-Angiotensin-Aldosterone System inhibitors: a systematic review and meta-analysis

AbstractInhibitors of the Renin-Angiotensin-Aldosterone System (RAAS) notably Angiotensin-Converting Enzyme inhibitors (ACEi) or Angiotensin Receptor Blockers (ARB) have been scrutinised in hypertensive patients hospitalised with coronavirus disease 2019 (COVID-19) following some initial data they might adversely affect prognosis. With an increasing number of COVID-19 cases worldwide and the likelihood of a “second wave” of infection it is imperative to better understand the impact RAAS inhibitor use in antihypertensive covid positive hospitalised patients.A systematic review and meta-analysis of ACEi or ARB in patients admitted with COVID-19 was conducted. PubMed and Embase were searched and six studies were included in the meta-analysis. Pooled analysis demonstrated that 18.3% of the patients admitted with COVID-19 were prescribed ACEi/ARBs (0.183, CI 0.129 to 0.238, p<0.001). The use of RAAS inhibitors did not show any association with ‘critical’ events (Pooled OR 0.833 CI 0.605 to 1.148, p=0.264) or death (Pooled OR 0.650, CI 0.356 to 1.187, p=0.161). In conclusion, our meta-analysis including ‘critical’ events and mortality data on patients prescribed ACEi/ARB and hospitalised with COVID-19, found no evidence to associate ACEi/ARB with death or adverse events.

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Hypertension, renin-angiotensin-aldosterone-system-blocking agents, and COVID-19

Clinical Hypertension ◽

10.1186/s40885-021-00168-0 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Si-Hyuck Kang ◽

Dong-Hoon Lee ◽

Kyung-Do Han ◽

Jin-Hyung Jung ◽

Sang-Hyun Park ◽

...

Keyword(s):

Angiotensin Receptor Blockers ◽

Clinical Severity ◽

Primary Study ◽

Converting Enzyme Inhibitors ◽

Renin Angiotensin Aldosterone System ◽

Renin Angiotensin ◽

Blocking Agents ◽

Increased Risk ◽

The Impact ◽

Multivariable Adjustment

Abstract Background There have been concerns regarding the safety of renin-angiotensin-aldosterone-system (RAAS)-blocking agents including angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) during the coronavirus disease 2019 (COVID-19) pandemic. This study sought to evaluate the impact of hypertension and the use of ACEI/ARB on clinical severity in patients with COVID-19. Methods A total of 3,788 patients aged 30 years or older who were confirmed with COVID-19 with real time reverse transcription polymerase chain reaction were identified from a claims-based cohort in Korea. The primary study outcome was severe clinical events, a composite of intensive care unit admission, need for ventilator care, and death. Results Patients with hypertension (n = 1,190, 31.4 %) were older and had higher prevalence of comorbidities than those without hypertension. The risk of the primary study outcome was significantly higher in the hypertension group, even after multivariable adjustment (adjusted odds ratio [aOR], 1.67; 95 % confidence interval [CI], 1.04 to 2.69). Among 1,044 patients with hypertensive medical treatment, 782 (74.9 %) were on ACEI or ARB. The ACEI/ARB subgroup had a lower risk of severe clinical outcomes compared to the no ACEI/ARB group, but this did not remain significant after multivariable adjustment (aOR, 0.68; 95 % CI, 0.41 to 1.15). Conclusions Patients with hypertension had worse COVID-19 outcomes than those without hypertension, while the use of RAAS-blocking agents was not associated with increased risk of any adverse study outcomes. The use of ACE inhibitors or ARBs did not increase the risk of adverse COVID-19 outcomes, supporting current guidance to continue these medications when indicated.

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Clinical Outcome of Renin-Angiotensin-Aldosterone System Blockers in Treatment of Hypertensive Patients with COVID-19: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-69847/v1 ◽

2020 ◽

Author(s):

Andrea Laurentius ◽

Brian Mendel ◽

Radityo Prakoso

Keyword(s):

Clinical Outcome ◽

Antihypertensive Drugs ◽

Angiotensin Receptor Blockers ◽

Meta Analysis ◽

Heart Association ◽

Hospital Treatment ◽

Converting Enzyme Inhibitors ◽

Renin Angiotensin Aldosterone System ◽

Hypertensive Patients ◽

Renin Angiotensin

Abstract Background: Novel coronavirus disease 2019 has been stated as global disease pandemic due to its rapid spread worldwide. Up to 30% of Coronavirus Disease 2019 patients with hypertension are more susceptible to death. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers has been used as primary line of medication for hypertension; nonetheless, conflicting data arises as numerous studies showed contradictory results. Methods: Aiming to show clinical outcome of renin-angiotensin-aldosterone system blockers in hospital treatment of hypertensive patients with Coronavirus Disease 2019, systematically searched literatures through eight databases were intensively appraised using Strengthening the Reporting of Observational Studies in Epidemiology checklists for cohort studies. Results: Six encompassed studies in this meta-review showed in-hospital hypertensive Coronavirus Disease 2019 patients receiving antihypertensive drugs were associated to overall risk reduction of all-cause mortalities (hazard ratio = 0.54, confidence interval 95% = 0.33 – 0.86). Conclusion: Therefore, the results support recommendation by American Heart Association not to discontinue antihypertension regimens in Coronavirus Disease 2019 patients with hypertension. Further researches are required as that majority of the studies are originated from Asian countries along with comprehensive standardization of baseline characteristics.

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What Is the Impact of Ambulatory Vital Sign Monitoring on Deterioration Detection and Related Clinical Outcomes in Hospitalised Patients: a Systematic Review and Meta-analysis.

10.21203/rs.3.rs-697407/v1 ◽

2021 ◽

Author(s):

Carlos Morgado Areia ◽

Christopher Biggs ◽

Mauro Santos ◽

Neal Thurley ◽

Stephen Gerry ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Standard Care ◽

Meta Analysis ◽

Ambulatory Monitoring ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Monitoring Systems ◽

Hospitalised Patients ◽

The Impact

Abstract Background: Timely recognition of the deteriorating inpatient remains challenging. Ambulatory monitoring systems (AMS) may augment current monitoring practices. However, there are many challenges to implementation in the hospital environment, and evidence describing the clinical impact of AMS on deterioration detection and patient outcome remains unclear. Objective: To assess the impact of vital signs monitoring on detection of deterioration and related clinical outcomes in hospitalised patients using ambulatory monitoring systems, in comparison with standard care.Methods: A systematic search was conducted in August 2020 using MEDLINE, Embase, CINAHL, Cochrane Database of Systematic Reviews, CENTRAL and Health Technology Assessment databases, as well as grey literature. Studies comparing the use of AMS against standard care for deterioration detection and related clinical outcomes in hospitalised patients were included. Deterioration related outcomes (primary) included unplanned intensive care admissions, rapid response team or cardiac arrest activation, total and major complications rate. Other clinical outcomes (secondary) included in-hospital mortality and hospital length of stay. Exploratory outcomes included alerting system parameters and clinical trial registry information. Results: Of 8706 citations, 10 studies with different designs met the inclusion criteria, of which 7 were included in the meta-analyses. Overall study quality was moderate. The meta-analysis indicated that the AMS, when compared with standard care, was associated with a reduction in intensive care transfers (risk ratio, RR, 0.87; 95% confidence interval, CI, 0.66 to 1.15), rapid response or cardiac arrest team activation (RR, 0.84; 95% CI 0.69 to 1.01), total (RR, 0.77; 95% CI 0.44 to 1.32) and major (RR, 0.55; 95% CI 0.24 to 1.30) complications prevalence. There was also association with reduced mortality (RR, 0.48; 95% CI 0.18 to 1.29) and hospital length of stay (mean difference, MD, -0.09; 95% CI -0.43 to 0.44). However, none were statistically significant.Conclusion: This systematic review indicates that implementation of AMS may have a positive impact on early deterioration detection and associated clinical outcomes, but differing design/quality of available studies and diversity of outcomes measures limits a definite conclusion. Our narrative findings suggested that alarms should be adjusted to minimise false alerts and promote rapid clinical action in response to deterioration.PROSPERO Registration number: CRD42020188633

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Angiotensin II antagonists and gastrointestinal bleeding in left ventricular assist devices: A systematic review and meta-analysis

The International Journal of Artificial Organs ◽

10.1177/0391398820951811 ◽

2020 ◽

pp. 039139882095181

Author(s):

Veraprapas Kittipibul ◽

Wasawat Vutthikraivit ◽

Jakrin Kewcharoen ◽

Pattara Rattanawong ◽

Pakpoom Tantrachoti ◽

...

Keyword(s):

Systematic Review ◽

Angiotensin Ii ◽

Gastrointestinal Bleeding ◽

Angiotensin Receptor Blockers ◽

Meta Analysis ◽

Angiotensin Converting Enzyme Inhibitors ◽

Left Ventricular ◽

Ventricular Assist Devices ◽

Left Ventricular Assist Devices ◽

Converting Enzyme Inhibitors

Gastrointestinal bleeding (GIB) especially from arteriovenous malformations (AVM) remains one of the devastating complications following continuous-flow left ventricular device (CF-LVAD) implantation. Blockade of angiotensin II pathway using angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) was reported to mitigate the risk of GIB and AVM-related GIB by suppressing angiogenesis. We performed a systematic review and meta-analysis to evaluate the association between ACEI/ARB treatment and GIB in CF-LVAD population. Comprehensive literature search was performed through December 2019. We included studies reporting risk of GIB and/or AVM-related GIB events in LVAD patients who received ACEI/ARB with those who did not. Data from each study were combined using the random-effects to calculate odd ratios and 95% confidence intervals. Three retrospective cohort studies were included in this meta-analysis involving 619 LVADs patients (467 patients receiving ACEI/ARB). The use of ACEI/ARB was statistically associated with decreased incidence of overall GIB (pooled OR 0.35, 95% CI 0.22–0.56, I2 = 0.0%, p < 0.001). There was a non-significant trend toward lower risk for AVM-related GIB in patients who received ACEI/ARB (pooled OR 0.46, 95% CI 0.19–1.07, I2 = 51%, p = 0.07). Larger studies with specific definitions of ACEI/ARB use and GIB are warranted to accurately determine the potential non-hemodynamic benefits of ACEI/ARB in CF-LVAD patients.

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