Renin-angiotensin-aldosterone system inhibitors and the risk of mortality in patients with hypertension hospitalised for COVID-19: Systematic review and meta-analysis

Anna E. Ssentongo*, Paddy Ssentongo, Emily S. Heilbrunn, Alain Lekoubou, Ping Du, Duanping Liao, John S. Oh, Vernon M. Chinchilli

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Objective The association between the use of renin-angiotensin-aldosterone (RAAS) inhibitors and the risk of mortality from COVID-19 is unclear. We aimed to estimate the association of RAAS inhibitors, including ACE inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) with COVID-19 mortality risk in patients with hypertension. Methods PubMed (MEDLINE) SCOPUS, OVID, Cochrane Library databases and were searched from 1 January 2020 to 1 September 2020. Studies reporting the association of RAAS inhibitors (ACEi or ARBs) and mortality in patients with hypertension, hospitalised for COVID-19 were extracted. Two reviewers independently extracted appropriate data of interest and assessed the risk of bias. All analyses were performed using random-effects models on log-transformed risk ratio (RR) estimates, and heterogeneity was quantified. Results Fourteen studies were included in the systematic review (n=73,073 patients with COVID-19; mean age 61 years; 53% male). Overall, the between-study heterogeneity was high (I 2 =80%, p<0.01). Patients with hypertension with prior use of RAAS inhibitors were 35% less likely to die from COVID-19 compared with patients with hypertension not taking RAAS inhibitors (pooled RR 0.65, 95% CI 0.45 to 0.94). The quality of evidence by Grading of Recommendations, Assessment, Development and Evaluations was graded as 'moderate' quality. Conclusions In this meta-analysis, with prior use of RAAS inhibitors was associated with lower risk mortality from COVID-19 in patients with hypertension. Our findings suggest a potential protective effect of RAAS-inhibitors in COVID-19 patients with hypertension. PROSPERO registration number The present study has been registered with PROSPERO (registration ID: CRD 42020187963).

Original languageEnglish
Article numbere001353
JournalOpen Heart
Issue number2
StatePublished - 5 Nov 2020
Externally publishedYes


  • antihypertensive drugs
  • hypertension
  • meta-analysis


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