{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:04:41Z","timestamp":1782486281385,"version":"3.54.5"},"reference-count":66,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T00:00:00Z","timestamp":1739836800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Hubei Chongxin Judical Expertise Center","award":["0231515045"],"award-info":[{"award-number":["0231515045"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ARM"],"abstract":"<jats:p>Objective: The primary objective of this study is to explore the potential link between the utilization of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) and its impact on mortality, disease severity, and healthcare resource utilization in individuals diagnosed with COVID-19. We aim to establish a solid theoretical foundation for safe and effective clinical medications. Methods: We conducted a comprehensive search of various databases, including CNKI, PubMed, Science, Cell, Springer, Nature, Web of Science, and Embase. We also traced the literature of the included studies to ensure a thorough analysis of the available evidence. After applying a set of inclusion and exclusion criteria, we ultimately included a total of 41 articles in our analysis. To determine the overall effect size for dichotomous variables, we used the Mantel\u2013Haenszel odds ratio in random effect models. For continuous variables, we calculated the inverse variance SMD using random effect models. To assess the outcomes and heterogeneity, we considered p-values (p &lt; 0.05) and I2 values for all outcomes. We performed multivariate and univariate meta-regression analyses using the maximum likelihood approach with the CMA 3.0 software. Results: The results of our analysis indicated that the use of ACEIs or ARBs did not significantly influence mortality (OR = 1.10, 95% CI 0.83\u20131.46, p = 0.43, I2 = 84%), severity (OR = 0.99, 95% CI 0.68\u20131.45, p = 0.98, I2 = 84%), or healthcare resource utilization (SMD = 0.03, 95% CI 0.06\u20130.12, p = 0.54, I2 = 37%) in patients with COVID-19 compared to those not taking ACEIs or ARBs. The multivariate meta-regression analysis model explained 63%, 31%, and 100% of the sources of heterogeneity for the three outcome indicators. Conclusions: The use of ACEIs and ARBs is not significantly correlated with mortality, severity, or healthcare resource utilization in patients with COVID-19, indicating safe clinical use of the medications.<\/jats:p>","DOI":"10.3390\/arm93010004","type":"journal-article","created":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T06:41:12Z","timestamp":1739860872000},"page":"4","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Meta-Analysis of the Impact of Using Angiotensin-Converting Enzyme Inhibitors (ACEIs) or Angiotensin II Receptor Blockers (ARBs) on Mortality, Severity, and Healthcare Resource Utilization in Patients with COVID-19"],"prefix":"10.3390","volume":"93","author":[{"given":"Ruijuan","family":"Li","sequence":"first","affiliation":[{"name":"Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Forensic Medicine, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430032, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"109920","DOI":"10.1016\/j.mehy.2020.109920","article-title":"Diacerein: A potential multi-target therapeutic drug for COVID-19","volume":"144","author":"Termini","year":"2020","journal-title":"Med. Hypotheses"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/j.jiph.2020.01.001","article-title":"Seroprevalence of MERS-CoV in healthy adults in western Saudi Arabia, 2011\u20132016","volume":"13","author":"Degnah","year":"2020","journal-title":"J. Infect. Public Health"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group, Sterne, J.A.C., Murthy, S., Diaz, J.V., Slutsky, A.S., Villar, J., Angus, D.C., Annane, D., Azevedo, L.C.P., and Berwanger, O. (2020). Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients with COVID-19: A Meta-analysis. JAMA, 324, 1330\u20131341.","DOI":"10.1001\/jama.2020.17023"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1007\/s43440-020-00204-0","article-title":"SARS-CoV-2 therapeutics: How far do we stand from a remedy?","volume":"73","author":"Singh","year":"2021","journal-title":"Pharmacol. Rep."},{"key":"ref_5","unstructured":"(2024, November 24). WHO Coronavirus (COVID-19) Dashboard|WHO Coronavirus (COVID-19) Dashboard with Vaccination Data. Available online: https:\/\/covid19.who.int\/."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1002\/jcp.29889","article-title":"The emerging role of angiotensinogen in cardiovascular diseases","volume":"236","author":"Xu","year":"2021","journal-title":"J. Cell. Physiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1038\/s41401-020-0430-6","article-title":"Recombinant human ACE2: Potential therapeutics of SARS-CoV-2 infection and its complication","volume":"41","author":"Pang","year":"2020","journal-title":"Acta Pharmacol. Sin."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1093\/ajh\/hpz146","article-title":"Angiotensin-(1-7): Translational Avenues in Cardiovascular Control","volume":"32","author":"Medina","year":"2019","journal-title":"Am. J. Hypertens."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Hikmet, F., M\u00e9ar, L., Edvinsson, \u00c5., Micke, P., Uhl\u00e9n, M., and Lindskog, C. (2020). The protein expression profile of ACE2 in human tissues. Mol. Syst. Biol., 16.","DOI":"10.15252\/msb.20209610"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"108175","DOI":"10.1016\/j.celrep.2020.108175","article-title":"A single-cell RNA expression map of human coronavirus entry factors","volume":"32","author":"Singh","year":"2020","journal-title":"Cell Rep."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Labandeira-Garcia, J.L., Labandeira, C.M., Valenzuela, R., Pedrosa, M.A., Quijano, A., and Rodriguez-Perez, A.I. (2022). Drugs Modulating Renin-Angiotensin System in COVID-19 Treatment. Biomedicines, 10.","DOI":"10.3390\/biomedicines10020502"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2000547","DOI":"10.1183\/13993003.00547-2020","article-title":"Comorbidity and its impact on 1590 patients with COVID-19 in China: A nationwide analysis","volume":"55","author":"Guan","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1001\/jama.2020.1585","article-title":"Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China","volume":"323","author":"Wang","year":"2020","journal-title":"JAMA"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1038\/s41401-020-0485-4","article-title":"Structural and functional properties of SARS-CoV-2 spike protein: Potential antivirus drug development for COVID-19","volume":"41","author":"Huang","year":"2020","journal-title":"Acta Pharmacol. Sin."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"33238","DOI":"10.1074\/jbc.M002615200","article-title":"A human homolog of angiotensin-converting enzyme. Cloning and functional expression as a captopril-insensitive carboxypeptidase","volume":"275","author":"Tipnis","year":"2000","journal-title":"J. Biol. Chem."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.cell.2020.02.058","article-title":"Structure, Function, and Antigenicity of the SARS-CoV-2 Spike Glycoprotein","volume":"181","author":"Walls","year":"2020","journal-title":"Cell"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1126\/science.abb2762","article-title":"Structural basis for the recognition of SARS-CoV-2 by full-length human ACE2","volume":"367","author":"Yan","year":"2020","journal-title":"Science"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1177\/0962280216669183","article-title":"Optimally estimating the sample mean from the sample size, median, mid-range, and\/or mid-quartile range","volume":"27","author":"Luo","year":"2018","journal-title":"Stat. Methods Med. Res."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Wan, X., Wang, W., Liu, J., and Tong, T. (2014). Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range. BMC Med. Res. Methodol., 14.","DOI":"10.1186\/1471-2288-14-135"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1016\/S2213-2600(21)00214-9","article-title":"Discontinuation versus continuation of renin-angiotensin-system inhibitors in COVID-19 (ACEI-COVID): A prospective, parallel group, randomised, controlled, open-label trial","volume":"9","author":"Bauer","year":"2021","journal-title":"Lancet Respir. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.amjcard.2020.07.007","article-title":"Angiotensin Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use Among Outpatients Diagnosed with COVID-19","volume":"132","author":"Bae","year":"2020","journal-title":"Am. J. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1002\/ejhf.1924","article-title":"Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers are not associated with severe COVID-19 infection in a multi-site UK acute hospital trust","volume":"22","author":"Bean","year":"2020","journal-title":"Eur. J. Heart Fail."},{"key":"ref_23","first-page":"399","article-title":"The Association Between Chronic Use of Renin\u2013Angiotensin-Aldosterone System Blockers and in-Hospital Adverse Events among COVID-19 Patients with Hypertension","volume":"54","author":"Cetinkal","year":"2020","journal-title":"Med. Bull. Sisli Etfal Hosp."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"801","DOI":"10.34067\/KID.0003792020","article-title":"Outcomes Associated with the Use of Renin-Angiotensin-Aldosterone System Blockade in Hospitalized Patients with SARS-CoV-2 Infection","volume":"1","author":"Chaudhri","year":"2020","journal-title":"Kidney360"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Choi, H.K., Koo, H., Seok, H., Jeon, J.H., Choi, W.S., Kim, D.J., Park, D.W., and Han, E. (2020). ARB\/ACEI use and severe COVID-19: A nationwide case-control study. medRxiv.","DOI":"10.1101\/2020.06.12.20129916"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/S2213-2600(20)30558-0","article-title":"Continuation versus discontinuation of renin-angiotensin system inhibitors in patients admitted to hospital with COVID-19: A prospective, randomised, open-label trial","volume":"9","author":"Cohen","year":"2021","journal-title":"Lancet Respir. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1111\/imj.15078","article-title":"Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers and prognosis of hypertensive patients hospitalised with COVID-19","volume":"50","author":"Covino","year":"2020","journal-title":"Intern. Med. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2709","DOI":"10.1007\/s12325-021-01704-y","article-title":"Mortality in Patients with COVID-19 on Renin Angiotensin System Inhibitor Long-Term Treatment: An Observational Study Showing that Things Are Not Always as They Seem","volume":"38","author":"Cugno","year":"2021","journal-title":"Adv. Ther."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"100962","DOI":"10.1016\/j.eclinm.2021.100962","article-title":"Telmisartan for treatment of Covid-19 patients: An open multicenter randomized clinical trial","volume":"37","author":"Duarte","year":"2021","journal-title":"eClinicalMedicine"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1093\/ajh\/hpaa096","article-title":"Use of RAAS Inhibitors and Risk of Clinical Deterioration in COVID-19: Results From an Italian Cohort of 133 Hypertensives","volume":"33","author":"Felice","year":"2020","journal-title":"Am. J. Hypertens."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1001\/jama.2020.11301","article-title":"Association of Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use with COVID-19 Diagnosis and Mortality","volume":"324","author":"Butt","year":"2020","journal-title":"JAMA"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1016\/j.jamda.2020.09.004","article-title":"COVID-19 In-Hospital Mortality and Use of Renin-Angiotensin System Blockers in Geriatrics Patients","volume":"21","author":"Genet","year":"2020","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1177\/1074248420976279","article-title":"Association of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Blockers with Severity of COVID-19: A Multicenter, Prospective Study","volume":"26","author":"Hakeam","year":"2021","journal-title":"J. Cardiovasc. Pharmacol. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"430","DOI":"10.21037\/atm.2020.03.229","article-title":"The effect of RAS blockers on the clinical characteristics of COVID-19 patients with hypertension","volume":"8","author":"Huang","year":"2020","journal-title":"Ann. Transl. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e2021004","DOI":"10.4178\/epih.e2021004","article-title":"Clinical outcomes of COVID-19 following the use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers among patients with hypertension in Korea: A nationwide study","volume":"43","author":"Kim","year":"2021","journal-title":"Epidemiol. Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1136\/jim-2021-002036","article-title":"Effect of renin-angiotensin system blocker on COVID-19 in young patients with hypertension","volume":"70","author":"Kuzeytemiz","year":"2022","journal-title":"J. Investig. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1111\/fcp.12613","article-title":"Outcome of patients hospitalized for COVID-19 and exposure to angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers in France: Results of the ACE-CoV study","volume":"35","author":"Lafaurie","year":"2021","journal-title":"Fundam. Clin. Pharmacol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.1093\/infdis\/jiaa447","article-title":"Continued In-Hospital Angiotensin-Converting Enzyme Inhibitor and Angiotensin II Receptor Blocker Use in Hypertensive COVID-19 Patients Is Associated with Positive Clinical Outcome","volume":"222","author":"Lam","year":"2020","journal-title":"J. Infect. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1001\/jamacardio.2020.1855","article-title":"Association of Angiotensin II Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors on COVID-19-Related Outcome","volume":"5","author":"Mehta","year":"2020","journal-title":"JAMA Cardiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1001\/jamacardio.2020.1624","article-title":"Association of Renin-Angiotensin System Inhibitors with Severity or Risk of Death in Patients with Hypertension Hospitalized for Coronavirus Disease 2019 (COVID-19) Infection in Wuhan, China","volume":"5","author":"Li","year":"2020","journal-title":"JAMA Cardiol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Lim, J.-H., Cho, J.-H., Jeon, Y., Kim, J.H., Lee, G.Y., Jeon, S., Noh, H.W., Lee, Y.-H., Lee, J., and Chang, H.-H. (2020). Adverse impact of renin\u2013angiotensin system blockade on the clinical course in hospitalized patients with severe COVID-19: A retrospective cohort study. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-76915-4"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1002\/jmv.26315","article-title":"Efficacy of ACEIs\/ARBs vs CCBs on the progression of COVID-19 patients with hypertension in Wuhan: A hospital-based retrospective cohort study","volume":"93","author":"Liu","year":"2021","journal-title":"J. Med. Virol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1001\/jama.2020.25864","article-title":"Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted with COVID-19: A Randomized Clinical Trial","volume":"325","author":"Lopes","year":"2021","journal-title":"JAMA"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.recesp.2020.05.030","article-title":"Impact of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on COVID-19 in a western population. CARDIOVID registry","volume":"74","year":"2021","journal-title":"Rev. Esp. Cardiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1080\/22221751.2020.1746200","article-title":"Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension","volume":"9","author":"Meng","year":"2020","journal-title":"Emerg. Microbes Infect."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1093\/ajh\/hpab111","article-title":"Effects of Renin\u2013Angiotensin\u2013Aldosterone Inhibitors on Early Outcomes of Hypertensive COVID-19 Patients: A Randomized Triple-Blind Clinical Trial","volume":"34","author":"Najmeddin","year":"2021","journal-title":"Am. J. Hypertens."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e14124","DOI":"10.1111\/ijcp.14124","article-title":"Comparison of losartan and amlodipine effects on the outcomes of patient with COVID-19 and primary hypertension: A randomised clinical trial","volume":"75","author":"Kalami","year":"2021","journal-title":"Int. J. Clin. Pract."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2447","DOI":"10.1093\/cid\/ciaa677","article-title":"Long-term ACE Inhibitor\/ARB Use Is Associated with Severe Renal Dysfunction and Acute Kidney Injury in Patients with Severe COVID-19: Results From a Referral Center Cohort in the Northeast of France","volume":"71","author":"Oussalah","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1093\/ajh\/hpaa149","article-title":"Effects of Angiotensin Receptor Blockers (ARBs) on In-Hospital Outcomes of Patients with Hypertension and Confirmed or Clinically Suspected COVID-19","volume":"33","author":"Soleimani","year":"2020","journal-title":"Am. J. Hypertens."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1053\/j.gastro.2020.05.034","article-title":"Associations Between Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blocker Use, Gastrointestinal Symptoms, and Mortality Among Patients with COVID-19","volume":"159","author":"Tan","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1007\/s11684-021-0850-9","article-title":"Renin-angiotensin system inhibitor is associated with the reduced risk of all-cause mortality in COVID-19 among patients with\/without hypertension","volume":"16","author":"Wang","year":"2022","journal-title":"Front. Med."},{"key":"ref_52","first-page":"e926651","article-title":"A Retrospective Study from 2 Centers in China on the Effects of Continued Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers in Patients with Hypertension and COVID-19","volume":"26","author":"Wang","year":"2020","journal-title":"Med. Sci. Monit."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1007\/s11684-020-0800-y","article-title":"Use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in context of COVID-19 outbreak: A retrospective analysis","volume":"14","author":"Xu","year":"2020","journal-title":"Front. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1161\/HYPERTENSIONAHA.120.15143","article-title":"Effects of Angiotensin II Receptor Blockers and ACE (Angiotensin-Converting Enzyme) Inhibitors on Virus Infection, Inflammatory Status, and Clinical Outcomes in Patients with COVID-19 and Hypertension: A Single-Center Retrospective Study","volume":"76","author":"Yang","year":"2020","journal-title":"Hypertension"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"617","DOI":"10.3904\/kjim.2020.656","article-title":"Different therapeutic associations of renin-angiotensin system inhibitors with coronavirus disease 2019 compared with usual pneumonia","volume":"36","author":"Lee","year":"2021","journal-title":"Korean J. Intern. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"300060520979151","DOI":"10.1177\/0300060520979151","article-title":"Impact of renin\u2013angiotensin system inhibitors use on mortality in severe COVID-19 patients with hypertension: A retrospective observational study","volume":"48","author":"Zhong","year":"2020","journal-title":"J. Int. Med. Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1080\/10641963.2020.1764018","article-title":"Clinical characteristics of coronavirus disease 2019 (COVID-19) patients with hypertension on renin\u2013angiotensin system inhibitors","volume":"42","author":"Zhou","year":"2020","journal-title":"Clin. Exp. Hypertens."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1631\/jzus.B2000730","article-title":"Effects of angiotensin II receptor blocker usage on viral load, antibody dynamics, and transcriptional characteristics among COVID-19 patients with hypertension","volume":"22","author":"Feng","year":"2021","journal-title":"J. Zhejiang Univ. Sci. B"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1038\/s41440-020-00535-8","article-title":"Renin-angiotensin system inhibitors and the severity of coronavirus disease 2019 in Kanagawa, Japan: A retrospective cohort study","volume":"43","author":"Matsuzawa","year":"2020","journal-title":"Hypertens. Res."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"47","DOI":"10.12998\/wjcc.v9.i1.47","article-title":"Angiotensin converting enzymes inhibitors or angiotensin receptor blockers should be continued in COVID-19 patients with hypertension","volume":"9","author":"Tian","year":"2021","journal-title":"World J. Clin. Cases"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1038\/s41371-022-00722-9","article-title":"The effects of antihypertensive medications on severity and outcomes of COVID19","volume":"36","author":"Agirbasli","year":"2022","journal-title":"J. Hum. Hypertens."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1002\/path.2987","article-title":"Acute respiratory distress syndrome leads to reduced ratio of ACE\/ACE2 activities and is prevented by angiotensin-(1-7) or an angiotensin II receptor antagonist","volume":"225","author":"Lutter","year":"2011","journal-title":"J. Pathol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"104350","DOI":"10.1016\/j.yexmp.2019.104350","article-title":"ACE2 exhibits protective effects against LPS-induced acute lung injury in mice by inhibiting the LPS-TLR4 pathway","volume":"113","author":"Ye","year":"2020","journal-title":"Exp. Mol. Pathol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1080\/08998280.2018.1499293","article-title":"Impact of angiotensin-converting enzyme inhibitors and statins on viral pneumonia","volume":"31","author":"Henry","year":"2018","journal-title":"Bayl. Univ. Med. Cent. Proc."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1038\/nature03712","article-title":"Angiotensin-converting enzyme 2 protects from severe acute lung failure","volume":"436","author":"Imai","year":"2005","journal-title":"Nature"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Mansour, E., Palma, A.C., Ulaf, R.G., Ribeiro, L.C., Bernardes, A.F., Nunes, T.A., Agrela, M.V., Bombassaro, B., Monfort-Pires, M., and Camargo, R.L. (2021). Safety and Outcomes Associated with the Pharmacological Inhibition of the Kinin\u2013Kallikrein System in Severe COVID-19. Viruses, 13.","DOI":"10.3390\/v13020309"}],"container-title":["Advances in Respiratory Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2543-6031\/93\/1\/4\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:36:45Z","timestamp":1760027805000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2543-6031\/93\/1\/4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,18]]},"references-count":66,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["arm93010004"],"URL":"https:\/\/doi.org\/10.3390\/arm93010004","relation":{},"ISSN":["2543-6031"],"issn-type":[{"value":"2543-6031","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,18]]}}}