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We aimed to provide a comprehensive\/updated evaluation of the effect of ACEIs\/ARBs on COVID\u201019\u2010related clinical outcomes, including exploration of interclass differences between ACEIs and ARBs, using a systematic review\/meta\u2010analysis approach conducted in Medline (OVID), Embase, Scopus, Cochrane library, and medRxiv from inception to 22 May 2020. English studies that evaluated the effect of ACEIs\/ARBs among patients with COVID\u201019 were included. Studies\u2019 quality was appraised using the Newcastle\u2010Ottawa Scale. Data were analyzed using the random\u2010effects modeling stratified by exposure (ACEIs\/ARBs, ACEIs, and ARBs). Heterogeneiity was assessed using I<jats:sup>2<\/jats:sup> statistic. Several subgroup analyses were conducted to explore the impact of potential confounders. Overall, 27 studies were eligible. The pooled analyses showed nonsignificant associations between ACEIs\/ARBs and death (OR:0.97, 95%CI:0.75,1.27), ICU admission (OR:1.09;95%CI:0.65,1.81), death\/ICU admission (OR:0.67; 95%CI:0.52,0.86), risk of COVID\u201019 infection (OR:1.01; 95%CI:0.93,1.10), severe infection (OR:0.78; 95%CI:0.53,1.15), and hospitalization (OR:1.15; 95%CI:0.81,1.65). However, the subgroup analyses indicated significant association between ACEIs\/ARBs and hospitalization among USA studies (OR:1.59; 95%CI:1.03,2.44), peer\u2010reviewed (OR:1.93, 95%CI:1.38,2.71), good quality and studies which reported adjusted measure of effect (OR:1.30, 95%CI:1.10,1.50). Significant differences were found between ACEIs and ARBs with the latter being significantly associated with lower risk of acquiring COVID\u201019 infection (OR:0.24; 95%CI: 0.17,0.34). In conclusion, high\u2010quality evidence exists for the effect of ACEIs\/ARBs on some COVID\u201019 clinical outcomes. For the first time, we provided evidence, albeit of low quality, on interclass differences between ACEIs and ARBs for some of the reported clinical outcomes.<\/jats:p>","DOI":"10.1002\/prp2.666","type":"journal-article","created":{"date-parts":[[2020,10,21]],"date-time":"2020-10-21T05:57:31Z","timestamp":1603259851000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["A systematic review and meta\u2010analysis of the use of renin\u2010angiotensin system drugs and COVID\u201019 clinical outcomes: What is the evidence so far?"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5036-1988","authenticated-orcid":false,"given":"Amanj","family":"Kurdi","sequence":"first","affiliation":[{"name":"Strathclyde Institute of Pharmacy and Biomedical Sciences University of Strathclyde Glasgow UK"},{"name":"Department of Pharmacology and Toxicology College of Pharmacy Hawler Medical University Kurdistan Region Government Erbil Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nouf","family":"Abutheraa","sequence":"additional","affiliation":[{"name":"Strathclyde Institute of Pharmacy and Biomedical Sciences University of Strathclyde Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Akil","sequence":"additional","affiliation":[{"name":"Strathclyde Institute of Pharmacy and Biomedical Sciences University of Strathclyde Glasgow UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Godman","sequence":"additional","affiliation":[{"name":"Strathclyde Institute of Pharmacy and Biomedical Sciences University of Strathclyde Glasgow UK"},{"name":"Division of Clinical Pharmacology Karolinska Institute Stockholm Sweden"},{"name":"Division of Public Health Pharmacy and Management School of Pharmacy Sefako Makgatho Health Sciences University Pretoria South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,20]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41569-020-0360-5"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2020.02.052"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30566-3"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvaa097"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.03.031"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00524-2020"},{"key":"e_1_2_12_8_1","volume-title":"COVID\u201019 and the use of angiotensin\u2010converting enzyme inhibitors and receptor blockers: scientific brief, 7 May 2020","author":"World Health Organization","year":"2020"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.004675"},{"key":"e_1_2_12_10_1","unstructured":"SparksM HiremathS. 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