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Safety and Efficacy of Renin-Angiotensin-Aldosterone System Inhibitors in COVID-19 Population.

Sattar, Yasar; Mukuntharaj, Pradeeksha; Zghouzi, Mohamed; Suleiman, Abdul-Rahman M.; Attique, Hassan; Ullah, Waqas; Khawar Sana, Muhammad; Zaher, Nathan; Mehmood, Maham; Doshi, Rajkumar P.; Panchal, Ankur; Mir, Tanveer; Nadeem, Muhammad; Ali, Omar E.; Mohamed, Mohamad; Bagur, Rodrigo; Elgendy, Islam Y.; Mamas, Mamas A.; Alraies, M. Chadi


Yasar Sattar

Pradeeksha Mukuntharaj

Mohamed Zghouzi

Abdul-Rahman M. Suleiman

Hassan Attique

Waqas Ullah

Muhammad Khawar Sana

Nathan Zaher

Maham Mehmood

Rajkumar P. Doshi

Ankur Panchal

Tanveer Mir

Muhammad Nadeem

Omar E. Ali

Mohamad Mohamed

Rodrigo Bagur

Islam Y. Elgendy

M. Chadi Alraies


INTRODUCTION: The safety of renin-angiotensin-aldosterone system inhibitors (RAASi) among COVID-19 patients has been controversial since the onset of the pandemic. METHODS: Digital databases were queried to study the safety of RAASi in COVID-19. The primary outcome of interest was mortality. The secondary outcome was seropositivity improvement/viral clearance, clinical manifestation progression, and progression to intensive care units. A random-effect model was used to compute an unadjusted odds ratio (OR). RESULTS: A total of 49 observational studies were included in the analysis consisting of 83,269 COVID-19 patients (RAASi n?=?34,691; non-RAASi n?=?48,578). The mean age of the sample was 64, and 56% were males. We found that RAASi was associated with similar mortality outcomes as compared to non-RAASi groups (OR 1.07; 95% CI 0.99-1.15; p?>?0.05). RAASi was associated with seropositivity improvement including negative RT-PCR or antibodies, (OR 0.96; 95% CI 0.93-0.99; p?<?0.05). There was no association between RAASi versus control with progression to ICU admission (OR 0.99; 95% CI 0.79-1.23; p?>?0.05) or higher odds of worsening of clinical manifestations (OR 1.04; 95% CI 0.97-1.11; p?>?0.05). Metaregression analysis did not change our outcomes for effect modifiers including age, sex, comorbidities, RAASi type, or study type on outcomes. CONCLUSIONS: COVID-19 is not a contraindication to hold or discontinue RAASi as they are not associated with higher mortality or worsening symptoms. Continuation of RAASi might be associated with favorable outcomes in COVID-19, including seropositivity/viral clearance.

Acceptance Date May 19, 2021
Publication Date Jul 1, 2021
Journal High Blood Pressure and Cardiovascular Prevention
Print ISSN 1120-9879
Publisher Springer Verlag
Pages 405 - 416
Publisher URL