{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T18:03:21Z","timestamp":1793815401668,"version":"4.6.1"},"reference-count":65,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"17","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,9,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Published randomized controlled trials are underpowered for binary clinical end points to assess the safety and efficacy of renin\u2010angiotensin system inhibitors (RASi) in adults with COVID\u201019. We therefore performed a meta\u2010analysis to assess the safety and efficacy of RASi in adults with COVID\u201019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      MEDLINE, EMBASE,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      , and the Cochrane Controlled Trial Register were searched for randomized controlled trials that randomly assigned patients with COVID\u201019 to RASi continuation\/commencement versus no RASi therapy. The primary outcome was all\u2010cause mortality at \u226430\u2009days. A total of 14 randomized controlled trials met the inclusion criteria and enrolled 1838 participants (aged 59\u2009years, 58% men, mean follow\u2010up 26\u2009days). Of the trials, 11 contributed data. We found no effect of RASi versus control on all\u2010cause mortality (7.2% versus 7.5%; relative risk [RR], 0.95; [95% CI, 0.69\u20131.30]) either overall or in subgroups defined by COVID\u201019 severity or trial type. Network meta\u2010analysis identified no difference between angiotensin\u2010converting enzyme inhibitors versus angiotensin II receptor blockers. RASi users had a nonsignificant reduction in acute myocardial infarction (2.1% versus 3.6%; RR, 0.59; [95% CI, 0.33\u20131.06]), but increased risk of acute kidney injury (7.0% versus 3.6%; RR, 1.82; [95% CI, 1.05\u20133.16]), in trials that initiated and continued RASi. There was no increase in need for dialysis or differences in congestive cardiac failure, cerebrovascular events, venous thromboembolism, hospitalization, intensive care admission, inotropes, or mechanical ventilation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">This meta\u2010analysis of randomized controlled trials evaluating angiotensin\u2010converting enzyme inhibitors\/angiotensin II receptor blockers versus control in patients with COVID\u201019 found no difference in all\u2010cause mortality, a borderline decrease in myocardial infarction, and an increased risk of acute kidney injury with RASi. Our findings provide strong evidence that RASi can be used safely in patients with COVID\u201019.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.122.026143","type":"journal-article","created":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T05:04:04Z","timestamp":1661317444000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":43,"title":["Renin\u2010Angiotensin System Inhibitors in Patients With COVID\u201019: A Meta\u2010Analysis of Randomized Controlled Trials Led by the International Society of Hypertension"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4145-6461","authenticated-orcid":false,"given":"Sonali R.","family":"Gnanenthiran","sequence":"first","affiliation":[{"name":"The George Institute for Global Health University of New South Wales Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8039-8781","authenticated-orcid":false,"given":"Claudio","family":"Borghi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences University of Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan","family":"Burger","sequence":"additional","affiliation":[{"name":"Department of Cellular and Molecular Medicine, Kidney Research Centre, Ottawa Hospital Research Institute University of Ottawa Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6718-8456","authenticated-orcid":false,"given":"Bruno","family":"Caramelli","sequence":"additional","affiliation":[{"name":"Interdisciplinary Medicine in Cardiology Unit, InCor University of Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadi","family":"Charchar","sequence":"additional","affiliation":[{"name":"School of Health and Life Sciences Federation University Australia Ballarat VIC Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9035-5670","authenticated-orcid":false,"given":"Julio A.","family":"Chirinos","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4649-079X","authenticated-orcid":false,"given":"Jordana B.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Renal\u2010Electrolyte and Hypertension Division and Department of Biostatistics, Epidemiology, and Informatics University of Pennsylvania Perelman School of Medicine Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Cremer","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Hypertension, Hypertension Excellence Center H\u00f4pital Saint Andr\u00e9, Centre Hospitalier Universitaire de Bordeaux &amp; University Bordeaux Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5470-3567","authenticated-orcid":false,"given":"Gian Luca","family":"Di Tanna","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health University of New South Wales Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Duvignaud","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Tropical Medicine, Division of Tropical Medicine and Clinical International Health H\u00f4pital Pellegrin, Centre Hospitalier Universitaire de Bordeaux &amp; University Bordeaux Bordeaux France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Freilich","sequence":"additional","affiliation":[{"name":"Bassett Medical Center Cooperstown NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. 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