Evaluating the renin-angiotensin-aldosterone system inhibitors effects on mortality and disease severity in patients with COVID-19

This review analyzed the effect of renin-angiotensin-aldosterone system (RAAS) inhibitors including angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) on patient prognosis for COVID-19. The data suggested that there is no association between the use of ACEIs/ARBs and the risk of mortality and disease severity in patients with COVID-19.

High blood pressure (HBP; hypertension) and heart disease (HD) are two conditions commonly seen in patients hospitalized with COVID-19. Some studies suggested a possible association between the occurrence of these conditions and a higher risk of mortality and disease severity in patients. ACEIs and ARBs are medications commonly used to reduce HBP.

Angiotensin-converting enzyme (ACE) is a protein receptor that is responsible for converting the protein angiotensin I to angiotensin II. Angiotensin II constricts blood vessels, resulting in increased blood pressure.

ACEIs and ARBs block this mechanism, causing reduced blood pressure. ACE 2 (angiotensin-converting enzyme 2) is mainly found in the heart and kidneys. This protein receptor is important for COVID-19 virus entry into cells. There are concerns that ACEIs and ARBs may cause an increase in ACE 2 expression in the body, making virus entry easier. However, it remains unclear whether the use of ACEIs and ARBs results in higher mortality and disease severity in patients with COVID-19.

This review included 7 randomized controlled studies with 1,321 patients with COVID-19. Patients in the treatment group were treated with either ACEIs or ARBs. 203 patients were treated with ACEIs, while 456 patients received ARBs. Patients in the control group received no ACEIs or ARBs alone or in combination with other medications.

There was no association between the use of ACEI or ARB treatment and a higher risk of mortality or disease severity. 

ARB use was associated with significant mortality reduction (by 77%) compared to the control group. ARB use was also associated with a significant reduction of disease severity (by 62%) compared to the control group. 

The study showed that the use of ACEIs or ARBs did not increase the risk of mortality or severity of disease in patients with COVID-19.

This review included a relatively small number of randomized, controlled studies. Further studies are needed.