{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T12:40:13Z","timestamp":1763037613838,"version":"3.41.2"},"reference-count":67,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,4,26]],"date-time":"2021-04-26T00:00:00Z","timestamp":1619395200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) share a target receptor with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The use of ACEIs\/ARBs may cause angiotensin-converting enzyme 2 receptor upregulation, facilitating the entry of SARS-CoV-2 into host cells. There is concern that the use of ACEIs\/ARBs could increase the risks of severe COVID-19 and mortality. The impact of discontinuing these drugs in patients with COVID-19 remains uncertain. We aimed to assess the association between the use of ACEIs\/ARBs and the risks of mortality and severe disease in patients with COVID-19. A systematic search was performed in PubMed, EMBASE, Cochrane Library, and<jats:ext-link>MedRxiv.org<\/jats:ext-link>from December 1, 2019, to June 20, 2020. We also identified additional citations by manually searching the reference lists of eligible articles. Forty-two observational studies including 63,893 participants were included. We found that the use of ACEIs\/ARBs was not significantly associated with a reduction in the relative risk of all-cause mortality [odds ratio (OR) = 0.87, 95% confidence interval (95% CI) = 0.75\u20131.00;<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>= 57%,<jats:italic>p<\/jats:italic>= 0.05]. We found no significant reduction in the risk of severe disease in the ACEI subgroup (OR = 0.95, 95% CI = 0.88\u20131.02,<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>= 50%,<jats:italic>p<\/jats:italic>= 0.18), the ARB subgroup (OR = 1.03, 95% CI = 0.94\u20131.13,<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>= 62%,<jats:italic>p<\/jats:italic>= 0.48), or the ACEI\/ARB subgroup (OR = 0.83, 95% CI = 0.65\u20131.08,<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>= 67%,<jats:italic>p<\/jats:italic>= 0.16). Moreover, seven studies showed no significant difference in the duration of hospitalization between the two groups (mean difference = 0.33, 95% CI = \u22121.75 to 2.40,<jats:italic>p<\/jats:italic>= 0.76). In conclusion, the use of ACEIs\/ARBs appears to not have a significant effect on mortality, disease severity, or duration of hospitalization in COVID-19 patients. On the basis of the findings of this meta-analysis, there is no support for the cessation of treatment with ACEIs or ARBs in patients with COVID-19.<\/jats:p>","DOI":"10.3389\/fcvm.2021.609857","type":"journal-article","created":{"date-parts":[[2021,4,26]],"date-time":"2021-04-26T04:26:50Z","timestamp":1619411210000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Associations Between the Use of Renin\u2013Angiotensin System Inhibitors and the Risks of Severe COVID-19 and Mortality in COVID-19 Patients With Hypertension: A Meta-Analysis of Observational 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