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Table 1 Characteristics of the studies

From: Risk of SARS-CoV-2 infection and COVID-19 prognosis with the use of renin–angiotensin–aldosterone system (RAAS) inhibitors: a systematic review

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 Drugs not associated with need for intensive care Not yet peer-reviewed (as at the time of the study)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ARBs/ACEIs appeared to reduce morbidity and mortality in COVID-19 Small sample size, single-centre, short follow-up, not peer-reviewed (as at the time of this study)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elderly Retrospective Drugs associated with decreased disease severity Small sample size of understudied groups, not peer-reviewed (as at the time of the study)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