# 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

## TL;DR

This study finds that using ACE inhibitors or ARBs does not significantly affect mortality, severity, or healthcare use in patients with COVID-19.

## Contribution

A comprehensive meta-analysis resolving prior inconsistencies about the impact of ACEIs and ARBs on COVID-19 outcomes.

## Key findings

- ACEIs and ARBs do not significantly influence mortality in patients with COVID-19.
- The use of ACEIs and ARBs is not correlated with increased disease severity or healthcare resource utilization.
- Multivariate meta-regression explains a significant portion of heterogeneity in the outcomes.

## Abstract

This study addresses a critical question about the impact of ACEIs and ARBs on COVID-19, offering valuable insights through a robust meta-analysis. Its strength lies in professional statistical evaluation across diverse datasets, resolving prior inconsistencies.

What are the main findings?
The use of ACEIs and ARBs presents both advantages and disadvantages for patients with COVID-19.The utilization of ACEIs and ARBs does not demonstrate a substantial correlation with mortality, severity, or healthcare resource utilization in patients with COVID-19.

The use of ACEIs and ARBs presents both advantages and disadvantages for patients with COVID-19.

The utilization of ACEIs and ARBs does not demonstrate a substantial correlation with mortality, severity, or healthcare resource utilization in patients with COVID-19.

What is the implication of the main finding?
The utilization of ACEIs and ARBs in patients diagnosed with COVID-19 is associated with benefits that outweigh the potential drawbacks.The utilization of ACEIs and ARBs has been shown to be safe medical practice.

The utilization of ACEIs and ARBs in patients diagnosed with COVID-19 is associated with benefits that outweigh the potential drawbacks.

The utilization of ACEIs and ARBs has been shown to be safe medical practice.

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–Haenszel 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 < 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 0.83–1.46, p = 0.43, I2 = 84%), severity (OR = 0.99, 95% CI 0.68–1.45, p = 0.98, I2 = 84%), or healthcare resource utilization (SMD = 0.03, 95% CI 0.06–0.12, 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.