{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T10:36:08Z","timestamp":1762079768136,"version":"3.40.5"},"reference-count":39,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2020,11,16]],"date-time":"2020-11-16T00:00:00Z","timestamp":1605484800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001030","name":"National Heart Foundation of Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010443","name":"RACP Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010443","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Internal Medicine Journal"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Severe acute respiratory syndrome coronavirus 2 (SARS\u2010CoV\u20102), the causative agent of COVID\u201019, enters human cells by binding of its viral protein to the aminopeptidase angiotensin\u2010converting enzyme 2 (ACE2). This has led to speculation whether treatment with renin\u2013angiotensin system (RAS) inhibitors was associated with an increased likelihood of a positive test for COVID\u201019 and risk of mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>We performed a systematic review and meta\u2010analysis to investigate whether RAS inhibitors increased the likelihood of a positive test or death\/severe illness in patients with COVID\u201019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic search of MEDLINE, PubMed and EMBASE was conducted for studies stratified by the use of angiotensin\u2010converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB). Pooled analysis was performed using a random\u2010effects model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seven trials of 73\u2009122 patients were included. Overall, 16\u2009624 (22.7%) patients had a positive COVID\u201019 test and 7892 (10.8%) were on a RAS inhibitor. RAS inhibitors were not associated with higher likelihood of a positive COVID\u201019 test result (odds ratio (OR) 0.97 (95% CI 0.97\u20131.05, <jats:italic>P<\/jats:italic> =\u20090.48) with low heterogeneity. This was comparable when stratifying by use of each medication class. The use of RAS inhibitors was also not associated with mortality or severe illness (OR 0.89, 95% CI 0.73\u20131.07, <jats:italic>P<\/jats:italic> =\u20090.21) with moderate heterogeneity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Use of ACEI or ARB was not associated with a heightened susceptibility for a positive diagnosis of COVID\u201019. Furthermore, they were not associated with increased illness severity or mortality due to COVID\u201019. Randomised controlled trials are needed to address definitively the potential benefits or harms of RAS inhibitors in patients with COVID\u201019.<\/jats:p><\/jats:sec>","DOI":"10.1111\/imj.15002","type":"journal-article","created":{"date-parts":[[2020,11,16]],"date-time":"2020-11-16T08:35:37Z","timestamp":1605515737000},"page":"1468-1474","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Renin\u2013angiotensin system inhibition and risk of infection and mortality in COVID\u201019: a systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8741-8631","authenticated-orcid":false,"given":"Anoop N.","family":"Koshy","sequence":"first","affiliation":[{"name":"Department of Cardiology Austin Health  Melbourne Victoria Australia"},{"name":"Department of Medicine The University of Melbourne, Melbourne  Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4248-7537","authenticated-orcid":false,"given":"Alexandra C.","family":"Murphy","sequence":"additional","affiliation":[{"name":"Department of Cardiology Austin Health  Melbourne Victoria Australia"},{"name":"Department of Medicine The University of Melbourne, Melbourne  Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omar","family":"Farouque","sequence":"additional","affiliation":[{"name":"Department of Cardiology Austin Health  Melbourne Victoria Australia"},{"name":"Department of Medicine The University of Melbourne, Melbourne  Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jay","family":"Ramchand","sequence":"additional","affiliation":[{"name":"Department of Cardiology Austin Health  Melbourne Victoria Australia"},{"name":"Department of Medicine The University of Melbourne, Melbourne  Victoria Australia"},{"name":"Heart and Vascular Institute Cleveland Clinic Miller Family Heart and Vascular Institute  Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Louise M.","family":"Burrell","sequence":"additional","affiliation":[{"name":"Department of Cardiology Austin Health  Melbourne Victoria Australia"},{"name":"Department of Medicine The University of Melbourne, Melbourne  Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matias B.","family":"Yudi","sequence":"additional","affiliation":[{"name":"Department of Cardiology Austin Health  Melbourne Victoria Australia"},{"name":"Department of Medicine The University of Melbourne, Melbourne  Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,11,16]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2020.02.052"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.104.510461"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1313"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000002450"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajplung.00152.2020"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.03530320"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsr2005760"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjcvp\/pvaa021"},{"key":"e_1_2_6_10_1","unstructured":"European Society of Cardiology. Position Statement of the ESC Council on Hypertension on ACE\u2010Inhibitors and Angiotensin Receptor Blockers. [cited 2020 May 10]. Available from URL:https:\/\/www.escardio.org\/Councils\/Council-on-Hypertension-(CHT)\/News\/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang"},{"key":"e_1_2_6_11_1","unstructured":"American College of Cardiology. HFSA\/ACC\/AHA Statement Addresses Concerns Re: Using RAAS Antagonists in COVID\u201019. [cited 2020 May 10]. 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