{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:16:10Z","timestamp":1760148970100,"version":"build-2065373602"},"reference-count":66,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T00:00:00Z","timestamp":1687737600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Angiotensin II-converting enzyme inhibitors (ACEIs) and selective angiotensin II receptor antagonists (ARAIIs) are widely used antihypertensive agents. Their use has generated controversy due to their possible influence on the health status of chronic patients infected with COVID-19. The objective of this work is to analyze the influence of COVID-19 on chronic hypertensive patients treated with ACEI and ARAII inhibitors. A systematic review and meta-analysis in the databases Pubmed, Pro-Quest and Scopus were carried out. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search equation descriptors were obtained from the Medical Subject Headings (MeSH) thesaurus. The search equation was: \u201cOlder AND hypertension AND (COVID-19 OR coronavirus) AND primary care\u201d and its equivalent in Spanish. Nineteen articles were obtained, with n = 10,806,159 subjects. Several studies describe the COVID-19 association with ACEI or ARAII treatment in hypertension patients as a protective factor, some as a risk factor, and others without a risk association. In the case of ACEI vs. ARAII, the risk described for the former has an odds ratio (OR) of 0.55, and for ARAII, an OR of 0.59. Some authors talk about mortality associated with COVID-19 and ACEI with a half ratio (HR) of 0.97, and also associated ARAIIs with an HR of 0.98. It is recommended to maintain the use of the renin\u2013angiotensin\u2013aldosterone axis in the context of the COVID-19 disease.<\/jats:p>","DOI":"10.3390\/medicina59071200","type":"journal-article","created":{"date-parts":[[2023,6,26]],"date-time":"2023-06-26T03:14:56Z","timestamp":1687749296000},"page":"1200","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["COVID-19 and the Use of Angiotensin II Receptor Blockers in Older Chronic Hypertensive Patients: Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"59","author":[{"given":"Miguel","family":"Quesada-Caballero","sequence":"first","affiliation":[{"name":"La Caleta Healthcare Unit, Granada-Metropolitan Health District, Andalusian Health Service, 18014 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Carmona-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Primary Care Emergency Service, Granada-Metropolitan Health District, Andalusian Health Service, 18013 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Chami-Pe\u00f1a","sequence":"additional","affiliation":[{"name":"Serran\u00eda de Ronda Hospital, AGS \u2018Serran\u00eda de M\u00e1laga\u2019, Andalusian Health Service, 29400 Ronda, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2684-1778","authenticated-orcid":false,"given":"Luis","family":"Albend\u00edn-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Caser\u00eda de Montijo Health Center, Granada Metropolitan District, Andalusian Health Service, 18015 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1498-5766","authenticated-orcid":false,"given":"Cristina","family":"Membrive-Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Unidad de Farmacogenetica, Servicio de Farmacia Hospitalaria, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas, 2, 18014 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5310-9638","authenticated-orcid":false,"given":"Jos\u00e9 L.","family":"Romero-B\u00e9jar","sequence":"additional","affiliation":[{"name":"Department of Statistics and Operations Research, University of Granada, 18071 Granada, Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria (ibs. GRANADA), 18012 Granada, Spain"},{"name":"Institute of Mathematics, University of Granada (IMAG), 18011 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3012-3410","authenticated-orcid":false,"given":"Guillermo A.","family":"Ca\u00f1adas-De la Fuente","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Granada, 18016 Granada, Spain"},{"name":"Brain, Mind and Behaviour Research Center (CIMCYC), University of Granada, 18071 Granada, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,26]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the Region of the Americas [Directrices de la Organizaci\u00f3n Mundial de la Salud del 2021 sobre el tratamiento farmacol\u00f3gico de la hipertensi\u00f3n: Implicaciones de pol\u00edtica para la Regi\u00f3n de las Am\u00e9ricas]","volume":"46","author":"Campbell","year":"2022","journal-title":"Rev. Pan Am. Salud Publica"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/S0140-6736(21)01330-1","article-title":"Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: A pooled analysis of 1201 population-representative studies with 104 million participants","volume":"398","author":"Zhou","year":"2021","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1097\/XEB.0000000000000138","article-title":"The prevalence of disability among people with cancer, cardiovascular disease, chronic respiratory disease and\/or diabetes: A systematic review","volume":"16","author":"Lisy","year":"2018","journal-title":"Int. J. Evid. Based Healthc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1093\/eurheartj\/ehaa1061","article-title":"The year in cardiovascular medicine 2020: Heart failure and cardiomyopathies","volume":"42","author":"Bueno","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"948765","DOI":"10.3389\/fpubh.2022.948765","article-title":"Association between short-term exposure to ambient air pollution and heart failure: An updated systematic review and meta-analysis of more than 7 million participants","volume":"10","author":"Yang","year":"2023","journal-title":"Front. Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"21","DOI":"10.31128\/AFP-08-17-4312","article-title":"What are chronic conditions that contribute to multimorbidity?","volume":"47","author":"Gordon","year":"2018","journal-title":"Aust. J. Gen. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1161\/HYPERTENSIONAHA.120.15026","article-title":"2020 International Society of Hypertension Global Hypertension Practice Guidelines","volume":"75","author":"Unger","year":"2020","journal-title":"Hypertension"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.kint.2021.09.026","article-title":"Diagnosis and treatment of arterial hypertension 2021","volume":"101","author":"Ott","year":"2022","journal-title":"Kidney Int."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1016\/S0140-6736(21)00590-0","article-title":"Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: An individual participant-level data meta-analysis","volume":"397","author":"Adler","year":"2021","journal-title":"Lancet"},{"key":"ref_10","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_11","doi-asserted-by":"crossref","unstructured":"Kollias, A., Foukarakis, E., Karakousis, K., HYPEDIA Study Group, and Stergiou, G.S. (J. Hum. Hypertens., 2022). Implementation of the 2018 ESC\/ESH Guidelines for the management of hypertension in primary care: The HYPEDIA study, J. Hum. Hypertens., in press.","DOI":"10.1097\/01.hjh.0000748544.26037.4a"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1038\/s41564-020-0688-y","article-title":"Functional assessment of cell entry and receptor usage for SARS-CoV-2 and other lineage B betacoronaviruses","volume":"5","author":"Letko","year":"2020","journal-title":"Nat. Microbiol."},{"key":"ref_13","unstructured":"(2022, July 13). Guidance on Routine Immunization Services during COVID-19 Pandemic in the WHO European Region, 20 March 2020. Available online: https:\/\/www.who.int\/europe\/publications\/i\/item\/WHO-EURO-2020-1059-40805-55114."},{"key":"ref_14","unstructured":"(2022, July 13). Weekly Epidemiological Update on COVID-19\u201413 July 2022. Available online: https:\/\/www.who.int\/publications\/m\/item\/weekly-epidemiological-update-on-covid-19---13-july-2022."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1016\/j.cell.2020.02.052","article-title":"SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor","volume":"181","author":"Hoffmann","year":"2020","journal-title":"Cell"},{"key":"ref_16","first-page":"1422","article-title":"ACE2 Shedding and the Role in COVID-19","volume":"11","author":"Wang","year":"2021","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_17","first-page":"196","article-title":"Changes in antihypertensive treatment in surviving patients SARS-CoV-2 respiratory infection and its cardiovascular impact after one year of follow-up","volume":"158","year":"2022","journal-title":"Med. Clin."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"655","DOI":"10.7326\/M20-6976","article-title":"The Proportion of SARS-CoV-2 Infections That Are Asymptomatic: A Systematic Review","volume":"174","author":"Oran","year":"2021","journal-title":"Ann. Intern. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.regg.2020.05.004","article-title":"Revista Espa\u00f1ola de Geriatr\u00eda y Gerontolog\u00eda. Tratamiento y evoluci\u00f3n del s\u00edndrome de tormenta de citoquinas asociados a infecci\u00f3n por SARS-CoV-2 en pacientes octogenarios","volume":"55","author":"Luis","year":"2020","journal-title":"Rev. Esp. Geriatr. Gerontol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"100604","DOI":"10.1016\/j.lanepe.2023.100604","article-title":"Severe COVID-19 outcomes by cardiovascular risk profile in England in 2020: A population-based cohort study","volume":"27","author":"Davidson","year":"2023","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_22","unstructured":"(2022, July 14). Underlying Medical Conditions Associated with Higher Risk for Severe COVID-19: Information for Healthcare Professionals|CDC, Available online: https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/hcp\/clinical-care\/underlyingconditions.html."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"COVID-19 Forecasting Team (2022). Variation in the COVID-19 infection-fatality ratio by age, time, and geography during the pre-vaccine era: A systematic analysis. Lancet, 399, 1469\u20131488.","DOI":"10.1016\/S0140-6736(21)02867-1"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1001\/jama.2020.12603","article-title":"Persistent Symptoms in Patients After Acute COVID-19","volume":"324","author":"Bernabei","year":"2020","journal-title":"JAMA"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1038\/s41591-022-01689-3","article-title":"Long-term cardiovascular outcomes of COVID-19","volume":"28","author":"Xie","year":"2022","journal-title":"Nat. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"n160","DOI":"10.1136\/bmj.n160","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_27","unstructured":"Howick, J., Chalmers, I., Glasziou, P., Greenhalgh, T., Heneghan, C., Liberati, A., Moschetti, I., Phillips, B., and Thornton, H. (2021, October 30). Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence (Background Document). Available online: https:\/\/www.cebm.ox.ac.uk\/resources\/levels-of-evidence\/ocebm-levels-of-evidence."},{"key":"ref_28","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_29","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_30","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/S2213-2600(20)30558-0","article-title":"Continuation versus discontinuation of renin\u2013angiotensin 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_31","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/j.jamda.2020.06.018","article-title":"The Effects of ARBs, ACEis, and Statins on Clinical Outcomes of COVID-19 Infection Among Nursing Home Residents","volume":"21","author":"Bronselaer","year":"2020","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"600385","DOI":"10.3389\/fmed.2021.600385","article-title":"Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotensin Receptor Blockers (ARB) Are Protective against ICU Admission and Mortality for Patients with COVID-19 Disease","volume":"8","author":"ElAbd","year":"2021","journal-title":"Front. Med."},{"key":"ref_33","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_34","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1136\/heartjnl-2020-317393","article-title":"Risk of severe COVID-19 disease with ACE inhibitors and angiotensin receptor blockers: Cohort study including 8.3 million people Special populations","volume":"106","author":"Young","year":"2020","journal-title":"Heart"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e060305","DOI":"10.1136\/bmjopen-2021-060305","article-title":"Association of outpatient use of renin\u2013angiotensin\u2013aldosterone system blockers on outcomes of acute respiratory illness during the COVID-19 pandemic: A cohort study","volume":"12","author":"Jeffery","year":"2022","journal-title":"BMJ Open"},{"key":"ref_36","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_37","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1056\/NEJMoa2006923","article-title":"Renin-Angiotensin-Aldosterone System Blockers and the Risk of COVID-19","volume":"382","author":"Mancia","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Mazzoni, T., Maraia, Z., Ruggeri, B., Polidori, C., Micioni di Bonaventura, M.V., Armillei, L., Pomilio, I., and Mazzoni, I. (2022). Sartans and ACE Inhibitors: Mortality in Patients Hospitalized with COVID-19. Retrospective Study in Patients on Long-Term Treatment Who Died in the Italian Hospitals of Area Vasta n.5\u2014Marche Region. J. Clin. Med., 11.","DOI":"10.3390\/jcm11092580"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e98","DOI":"10.1016\/S2589-7500(20)30289-2","article-title":"Renin\u2013angiotensin system blockers and susceptibility to COVID-19: An international, open science, cohort analysis","volume":"3","author":"Morales","year":"2021","journal-title":"Lancet Digit. Health"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e017364","DOI":"10.1161\/JAHA.120.017364","article-title":"Antecedent Administration of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Antagonists and Survival After Hospitalization for COVID-19 Syndrome","volume":"9","author":"Palazzuoli","year":"2020","journal-title":"J. Am. Heart Assoc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e053393","DOI":"10.1136\/bmjopen-2021-053393","article-title":"Insights into the association of ACEIs\/ARBs use and COVID-19 prognosis: A multistate modelling study of nationwide hospital surveillance data from Belgium","volume":"11","author":"Genbrugge","year":"2021","journal-title":"BMJ Open"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2537","DOI":"10.1097\/HJH.0000000000002584","article-title":"Baseline use of angiotensin-converting enzyme inhibitor\/AT1blocker and outcomes in hospitalized coronavirus disease 2019 African-American patients","volume":"38","author":"Shah","year":"2020","journal-title":"J. Hypertens."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.ahj.2022.01.015","article-title":"A randomized controlled trial of renin-angiotensin-aldosterone system inhibitor management in patients admitted in hospital with COVID-19","volume":"247","author":"Sharma","year":"2022","journal-title":"Am. Heart J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1007\/s40264-020-00994-5","article-title":"Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Death in Patients Hospitalised with COVID-19: A Retrospective Italian Cohort Study of 43,000 Patients","volume":"43","author":"Massari","year":"2020","journal-title":"Drug Saf."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1161\/CIRCRESAHA.120.317134","article-title":"Association of Inpatient Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Mortality among Patients with Hypertension Hospitalized with COVID-19","volume":"126","author":"Zhang","year":"2020","journal-title":"Circ. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"f360","DOI":"10.1136\/bmj.f360","article-title":"Efficacy and safety of dual blockade of the renin-angiotensin system: Meta-analysis of randomised trials","volume":"346","author":"Makani","year":"2013","journal-title":"BMJ"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"20117","DOI":"10.1038\/s41598-022-24628-1","article-title":"The systemic renin-angiotensin system in COVID-19","volume":"12","author":"Domenig","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1186\/s12931-020-01580-0","article-title":"Clinical characteristics of 134 convalescent patients with COVID-19 in Guizhou, China","volume":"21","author":"Zhang","year":"2020","journal-title":"Respir. Res."},{"key":"ref_49","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_50","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1016\/j.medcli.2020.06.013","article-title":"Risk of severe COVID-19 in hypertensive patients treated with renin-angiotensin-aldosterone system inhibitors","volume":"155","author":"Golpe","year":"2020","journal-title":"Med. Clin."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1016\/S0140-6736(20)31030-8","article-title":"Use of renin-angiotensin-aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: A case-population study","volume":"395","author":"Lerma","year":"2020","journal-title":"Lancet"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1056\/NEJMsr2005760","article-title":"Renin\u2013Angiotensin\u2013Aldosterone System Inhibitors in Patients with COVID-19","volume":"382","author":"Vaduganathan","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.jjcc.2022.04.001","article-title":"Renin-angiotensin system blocker and the COVID-19 aggravation in patients with hypertension, diabetes, renal failure, Cerebro-cardiovascular disease, or pulmonary disease: Report by the COVID-19 Registry Japan","volume":"80","author":"Yoshihara","year":"2022","journal-title":"J. Cardiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e222735","DOI":"10.1001\/jamanetworkopen.2022.2735","article-title":"Efficacy of Losartan in Hospitalized Patients With COVID-19-Induced Lung Injury: A Randomized Clinical Trial","volume":"5","author":"Puskarich","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"25289","DOI":"10.1161\/JAHA.122.025289","article-title":"Renin-Angiotensin Aldosterone System Inhibitors and COVID-19: A Systematic Review and Meta-Analysis Revealing Critical Bias Across a Body of Observational Research","volume":"11","author":"Loader","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1002\/clc.23836","article-title":"Safety of ACEi and ARB in COVID-19 management: A retrospective analysis","volume":"45","author":"Kumar","year":"2022","journal-title":"Clin. Cardiol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1097\/FJC.0000000000001189","article-title":"Renin-Angiotensin System Blocker in COVID-19. A Single Center Study","volume":"79","author":"Job","year":"2022","journal-title":"J. Cardiovasc. Pharmacol."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Liu, Q., Fu, W., Zhu, C.J., Ding, Z.H., Dong, B.B., Sun, B.Q., and Chen, R.C. (2023). Effect of continuing the use of renin-angiotensin system inhibitors on mortality in patients hospitalized for coronavirus disease 2019: A systematic review, meta-analysis, and meta-regression analysis. BMC Infect. Dis., 23.","DOI":"10.1186\/s12879-023-07994-7"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1093\/ajh\/hpac001","article-title":"Effects of Renin-Angiotensin System Inhibitors on Mortality and Disease Severity of COVID-19 Patients: A Meta-analysis of Randomized Controlled Trials","volume":"35","author":"Yin","year":"2022","journal-title":"Am. J. Hypertens."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.tcm.2019.05.003","article-title":"Blood pressure and the new ACC\/AHA hypertension guidelines","volume":"30","author":"Flack","year":"2020","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1161\/HYPERTENSIONAHA.121.18192","article-title":"Hypertension Pharmacological Treatment in Adults: A World Health Organization Guideline Executive Summary","volume":"79","author":"DiPette","year":"2022","journal-title":"Hypertension"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1161\/HYPERTENSIONAHA.120.15989","article-title":"Renin-Angiotensin-Aldosterone System Inhibitors and Risks of Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Systematic Review and Meta-Analysis","volume":"76","author":"Chan","year":"2020","journal-title":"Hypertension"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Xiong, S., Liu, L., Lin, F., Shi, J., Han, L., Liu, H., He, L., Jiang, Q., Wang, Z., and Fu, W. (2020). Clinical characteristics of 116 hospitalized patients with COVID-19 in Wuhan, China: A single-centered, retrospective, observational study. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-05452-2"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1161\/HYPERTENSIONAHA.120.16314","article-title":"Antihypertensive Drugs and COVID-19 Risk: A Cohort Study of 2 Million Hypertensive Patients","volume":"77","author":"Semenzato","year":"2021","journal-title":"Hypertension"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"2601","DOI":"10.1161\/HYPERTENSIONAHA.122.19575","article-title":"Impact of Arterial Hypertension and Use of Antihypertensive Pharmacotherapy on Mortality in Patients Hospitalized due to COVID-19: The CRACoV-HHS Study","volume":"79","author":"Wojciechowska","year":"2022","journal-title":"Hypertension"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.amjcard.2021.12.004","article-title":"Usefulness of Combined Renin-Angiotensin System Inhibitors and Diuretic Treatment In Patients Hospitalized with COVID-19","volume":"167","author":"Palazzuoli","year":"2022","journal-title":"Am. J. Cardiol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/7\/1200\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:00:50Z","timestamp":1760126450000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/7\/1200"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,26]]},"references-count":66,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["medicina59071200"],"URL":"https:\/\/doi.org\/10.3390\/medicina59071200","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2023,6,26]]}}}