■据观察,2019年冠状病毒病(COVID-19)导致心脏代谢疾病患者的高死亡率。肾素-血管紧张素-醛固酮系统(RAAS)阻断剂可增强SARS-CoV-2的结合受体ACE2的表达,并可增强病毒的感染性。我们的目标是提供RAAS阻滞剂对COVID-19结局影响的汇总估计。
■使用MEDLINE/PubMed进行了文献检索,谷歌学者和预印本服务器。本研究包括所有分析RAAS受体阻滞剂对COVID-19患者临床结局影响的临床研究。纽卡斯尔-渥太华量表用于研究质量评估。遵循MOOSE检查表。死亡率和严重程度结果记录为合并比值比(OR)和95%置信区间(CI)和异质性水平(I2)。死亡几率是主要结果。严重程度的可能性,住院治疗,重症监护病房(ICU)入院,机械通气(MV),使用类固醇和急性肾损伤是次要结局.根据各自作者使用的定义选择严重性结果。还探讨了RAAS阻滞剂的各个类别的国家特定差异和影响。
■最终分析中总共包括了47项已发表的研究,共有26,432名患者来自31项研究的死亡率分析和20,127名患者来自23项研究的严重程度分析。没有增加死亡风险[汇集OR0.91(0.65-1.26),I2=89%]或严重性[汇集或1.08(0.79-1.46),I2=88%]使用RAAS阻断剂。该药物类别在高血压中具有保护性[汇总OR0.63(0.46-0.86),I2=58%]。欧洲人的COVID-19结果严重程度很高[汇集OR2.08(1.52-2.85),I2=77%]和美国患者[汇集OR1.87(1.62-2.17)]。在美国患者中观察到近4倍的住院风险和2倍的ICU入院和MV风险。Class-wise,使用血管紧张素受体阻滞剂与严重程度几率高1.6倍相关,主要是欧洲人。
■RAAS阻滞剂与COVID-19患者死亡率增加无关,应在高血压患者中继续使用。美国和欧洲患者的严重预后风险较高。药物遗传学差异可以解释种族相关的变化。
■RAAS阻断药物对COVID-19的影响背景和目标:在患有心脏病等其他长期疾病的COVID-19患者中观察到更高的死亡人数,糖尿病,还有高血压.这些患者中的许多人都开了一类称为RAAS阻滞剂(雷米普利,替米沙坦,etc).我们研究了这些药物的使用是否会使这些患者的COVID-19疾病恶化或导致过度死亡。方法:我们对COVID-19患者使用RAAS阻滞剂药物的47项观察性研究进行了汇总分析。结果:我们发现RAAS阻滞剂不会导致COVID-19患者过度死亡。相反,如果给高血压患者开处方,他们有好处。我们还发现,尽管服用这些药物的欧洲和美国COVID-19患者的疾病严重程度更高,中国患者的情况并非如此。结论:种族差异可能是遗传等因素造成的。
OBJECTIVE: Coronavirus disease 2019 (COVID-19) has been observed to cause a high mortality in people with cardiometabolic diseases. Renin-angiotensin-aldosterone system (
RAAS) blockers enhance the expression of ACE2, the binding receptor of SARS-CoV-2, and can enhance viral infectivity. We aim to provide a pooled estimate of the effect of
RAAS blockers on COVID-19 outcomes.
METHODS: A literature search was performed using MEDLINE/PubMed, Google Scholar and preprint servers. All clinical studies analyzing the effect of
RAAS blockers on clinical outcomes in COVID-19 patients were included in this study. Newcastle-Ottawa scale was used for quality assessment of studies. MOOSE checklist was followed. Mortality and severity outcomes were recorded as pooled odds ratio (OR) with 95% Confidence Intervals (CIs) and level of heterogeneity (I 2). Odds of mortality was the primary outcome. Odds of severity, hospitalization, intensive care unit (ICU) admission, mechanical ventilation (MV), steroid use and acute kidney injury were the secondary outcomes. Severity outcomes were chosen depending upon the definition used by respective authors. Country-specific variations and effects of individual class of
RAAS blockers were also explored.
RESULTS: In total 47 published studies were included in the final analysis, with a total of 26,432 patients from 31 studies in mortality analysis and 20,127 patients from 23 studies in severity analysis. No increased risk of mortality [Pooled OR 0.91 (0.65-1.26), I 2 = 89%] or severity [Pooled OR 1.08 (0.79-1.46), I 2 = 88%] was seen with RAAS blockers. The drug class was protective in hypertension [pooled OR 0.63 (0.46-0.86), I 2 = 58%]. Severity of COVID-19 outcomes was high for Europeans [Pooled OR 2.08 (1.52-2.85), I 2 = 77%] and US patients [Pooled OR 1.87 (1.62-2.17)]. Nearly 4 times higher risk of hospitalization and 2 times higher risk of ICU admission and MV were observed in US patients. Class-wise, angiotensin receptor blocker use was associated with 1.6 times higher odds of severity, mainly in Europeans.
CONCLUSIONS: RAAS blockers are not associated with increased mortality in COVID-19 patients and should be continued in hypertensives. US and European patients are at higher risk of severe outcomes. Pharmacogenetic differences may explain the ethnicity-related variations.
CONCLUSIONS: Effect of RAAS-blocking medicines on COVID-19 Background and aims: Higher deaths have been observed in COVID-19 patients who have other long-term diseases such as heart disease, diabetes, and high blood pressure. Many of these patients are prescribed a class of medicines called RAAS blockers (ramipril, telmisartan, etc). We studied whether the use of these medicines worsens the course of COVID-19 disease in these patients or causes excess deaths.Methods: We conducted a pooled analysis of 47 observational studies on the use of RAAS blocker drugs in COVID-19 patients.Results: We found that RAAS blockers do not cause excess deaths in patients with COVID-19. On the contrary, they have benefits if prescribed to those with high blood pressure. We also found that whereas European and US patients of COVID-19 taking these medicines had higher disease severity, this was not the case for Chinese patients.Conclusion: Theremay be some genetic and other factors responsible for differences by ethnicity.