Table 1 Characteristics of the studies
Study | Sample size | Study design | Outcomes | Limitations |
|---|---|---|---|---|
Mehta et al. 2020 [36], records from March 8 to April 12, 2020 | 1735 | Retrospective | No association between positive tests to COVID-19 and use of ACEI/ARB | Small sample size, inherent bias from observational studies |
Reynolds et al. 2020 [37], data from March 1 to April 15, 2020 | 5892 | Retrospective | No association between risk of positive tests to COVID-19 and risk of severe illness with use of ARB/ACEI | Small sample size, potential confounder bias |
Rentsch et al. 2020 [38], data from February 8 to March 30, 2020 | 585 | Retrospective | Encouraged continued use of ACEI/ARBs. Drugs not associated with need for intensive care | Not yet peer-reviewed (as at the time of the study) |
Mancia et al. 2020 [39], records from February 21 to March 11, 2020 | 6272 | Retrospective | ARB/ACEI use not associated with increased risk of contracting COVID-19, severity and mortality from the disease | Study design was not randomised |
Abajo et al. 2020 [43], health records from March 1 to March 24, 2020 | 1139 | Retrospective case–control | ARBs/ACEIs use did not increase risk for hospitalization in COVID-19 patients | Possible confounders |
Bean et al. 2020 [44], data from March 1 to March 22, 2020 | 205 | Observational (prospective) | ARBs/ACEIs appeared to reduce morbidity and mortality in COVID-19 | Small sample size, single-centre, short follow-up, not peer-reviewed (as at the time of this study) |
De Spiegeleer et al. 2020 [45], health record from March 1 to April 16, 2020 | 154 | Retrospective | ARB/ACEI use was neither associated with absence of COVID-19 symptoms nor serious clinical outcomes | Small sample size |
Li et al. 2020 [46], records from January 15 to March 15, 2020 | 1178 | Retrospective | ACEI/ARB use was not significantly associated with severity and mortality from COVID-19 | Single-centre study, not randomised |
Liu et al. 2020 [47], records from December 29, 2019 to February 29, 2020 | 511 elderly | Retrospective | Drugs associated with decreased disease severity | Small sample size of understudied groups, not peer-reviewed (as at the time of the study) |
Meng et al. 2020 [48], records from January 11 to February 23, 2020 | 42 | Retrospective | Lower levels of IL-6 and reduction in viral load, with the use of ACEIs/ARBs | Very small sample size |
Rossi et al. 2020 [49], health records from February 22 to April 2, 2020 | 2653 | Retrospective | Study drugs not associated with risk of mortality | Potential for confounders |
Yang et al. 2020 [50], data from January 5 to February 22, 2020 | 2068 | Retrospective | Lower case of critical illness and mortality in ARB/ACEI users | Single-centre, potential confounders |
Feng et al. 2020 [51], data from January 1 to February, 15, 2020 | 476 | Retrospective | Use of ACEIs/ARBs appeared to lower risks of severe COVID-19 illness | Potential confounders, small sample size |
Zhang et al. 2020 [52], data from December 31 2019 to February 20, 2020 | 1128 | Retrospective | ACEI/ARB use associated with lower mortality | Potential confounders |
Peng et al. 2020 [53], health records January 20 to February 15, 2020 | 112 | Retrospective | ACEIs/ARBs not associated with critical illness and mortality in COVID-19 | Small sample size |
Huang et al. 2020 [54], data from February 7 to March 3, 2020 | 50 | Retrospective | No significant difference in disease course in the use of ACEIs/ARBs and other classes of antihypertensive | Small sample size |
Zhang et al. 2020 [55], clinical data up to May 9, 2020 | 14 studies | Meta-analysis | ARBs/ACEIs not associated with higher risk of COVID-19 infection, severity and mortality | Potential confounders, small number of eligible studies |
Guo et al. 2020 [56], clinical data up to May 13, 2020 | 9 studies | Meta-analysis | ARB/ACEI use not associated with increase severity of COVID-19 | Potential confounders |