Meta-analysis finds survival benefit with RAAS inhibitors in COVID-19

  • Gao C & al.
  • Eur Heart J
  • 4 Jun 2020

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • A meta-analysis of data for patients hospitalized with COVID-19 shows a survival benefit with use of renin-angiotensin-aldosterone system (RAAS) inhibitors.
  • These meta-analysis results conflict with observational findings also reported in this article.

Why this matters

  • Because their observational findings were not in agreement with those of their meta-analysis, the authors say that the results should still be “considered as exploratory and interpreted cautiously.”

Key results

  • In keeping with many previous reports, mortality risk was increased for patients who had hypertension vs those without:
    • 4.0% vs 1.1%.
    • aHR, 2.12 (95% CI, 1.17-3.82).
    • Patients with hypertension also had increased risk for severe/critical disease, invasive mechanical ventilation.
  • Untreated hypertension also was linked to increased mortality risk vs being on treatment:
    • 7.9% vs 3.2%.
    • aHR, 2.17 (95% CI, 1.03-4.57).
  • Patients taking RAAS inhibitors did not differ in mortality risk from those taking some other antihypertensive:
    • 2.2% vs 3.6%.
    • aHR, 0.85 (95% CI, 0.28-2.58).
  • That finding contrasted with results of the meta-analysis of these data together with published data from 3 other Chinese groups, which showed a mortality risk reduction with RAAS inhibitor use:
    • Relative risk, 0.65 (95% CI, 0.45-0.94).

Study design

  • Retrospective, observational study of 2877 consecutive patients (850 with hypertension) hospitalized with COVID-19 in Wuhan, China.
  • Funding: None disclosed.

Limitations

  • Relatively small numbers with hypertension.
  • Observational, residual confounding risk.