{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T02:35:03Z","timestamp":1773455703451,"version":"3.50.1"},"reference-count":78,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,10,19]],"date-time":"2022-10-19T00:00:00Z","timestamp":1666137600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Despite the availability of extensive literature on the effect of angiotensin\u2010converting enzyme inhibitors (ACEIs)\/angiotensin\u2010receptor blockers (ARBs) on COVID\u201019 outcomes, the evidence is still controversial. We aimed to provide a comprehensive assessment of the effect of ACEIs\/ARBs on COVID\u201019\u2010related outcomes by summarising the currently available evidence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An umbrella review was conducted using Medline (OVID), Embase, Scopus, Cochrane library and medRxiv from inception to 1 February 2021. Systematic reviews with meta\u2010analysis that evaluated the effect of ACEIs\/ARBs on COVID\u201019\u2010related clinical outcomes were eligible. Studies' quality was appraised using the AMSTAR 2 Critical Appraisal Tool. Data were analysed using the random\u2010effects modelling including several subgroup analyses. Heterogenicity was assessed using I<jats:sup>2<\/jats:sup> statistic. The study protocol was registered in PROSPERO (CRD42021233398) and reported using PRISMA guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 47 reviews were eligible for inclusion. Out of the nine COVID\u201019 outcomes evaluated, there was significant associations between ACEIs\/ARBs use and each of death (OR\u00a0=\u00a00.80, 95%CI\u00a0=\u00a00.75\u20130.86; I<jats:sup>2<\/jats:sup>\u00a0=\u200951.9%), death\/ICU admission as composite outcome (OR\u00a0=\u00a00.86, 95%CI\u00a0=\u00a00.80\u20130.92; I<jats:sup>2<\/jats:sup>\u00a0=\u200943.9%), severe COVID\u201019 (OR\u00a0=\u00a00.86, 95%CI\u00a0=\u00a00.78\u20130.95; I<jats:sup>2<\/jats:sup>\u00a0=\u200968%) and hospitalisation (OR\u00a0=\u00a01.23, 95%CI\u00a0=\u00a01.04\u20131.46; I<jats:sup>2<\/jats:sup>\u00a0=\u200976.4%). The significant reduction in death\/ICU admission, however, was higher among studies which presented adjusted measure of effects (OR\u00a0=\u00a00.63, 95%CI\u00a0=\u00a00.47\u20130.84) and were of moderate quality (OR\u00a0=\u00a00.74, 95%CI\u00a0=\u00a00.63\u20130.85).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Collective evidence from observational studies indicate a good quality evidence on the significant association between ACEIs\/ARBs use and reduction in death and death\/ICU admission, but poor\u2010quality evidence on both reducing severe COVID\u201019 and increasing hospitalisation. Our findings further support the current recommendations of not discontinuing ACEIs\/ARBs therapy in patients with COVID\u201019.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.13888","type":"journal-article","created":{"date-parts":[[2022,10,7]],"date-time":"2022-10-07T14:12:05Z","timestamp":1665151925000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["An umbrella review and meta\u2010analysis of renin\u2013angiotensin system drugs use and <scp>COVID<\/scp>\u201019 outcomes"],"prefix":"10.1111","volume":"53","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 Science, University of Strathclyde  Glasgow Scotland UK"},{"name":"Department of Pharmacology and Toxicology College of Pharmacy, Kurdistan Region Government, Hawler Medical University  Erbil Iraq"},{"name":"Division of Public Health Pharmacy and Management School of Pharmacy, Sefako Makgatho Health Sciences University  Pretoria South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanja","family":"Mueller","sequence":"additional","affiliation":[{"name":"Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde  Glasgow Scotland UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie","family":"Weir","sequence":"additional","affiliation":[{"name":"Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde  Glasgow Scotland UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,10,19]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m3731"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsr2005760"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/1061186X.2020.1797754"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11883-020-00880-6"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2020.05.052"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.phrs.2020.104927"},{"issue":"3","key":"e_1_2_9_8_1","first-page":"132","article-title":"Summarizing systematic reviews: methodological development, conduct and reporting of an umbrella review approach","volume":"13","author":"Aromataris E","year":"2015","journal-title":"JBI Evidence Implementation"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.46658\/JBIMES-20-01"},{"key":"e_1_2_9_10_1","unstructured":"Covidence.Better systematic review management2022; 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