Effect of Renin-Angiotensin-Aldosterone System inhibitors on outcomes of COVID-19 patients with hypertension: Systematic review and Meta-analysis

  1. Tamirat Bekele Beressa
  2. Tamiru Sahilu
  3. Serawit Deyno

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Abstract

Objective

This research aimed to systematically review and summarize the influence of Renin-Angiotensin-Aldosterone System ( RAAS) inhibitors on the outcome of COVID_19 patients with hypertension.

Methods

Electronic databases; PubMed/Medline, CINAHL, the Cochrane Central Register of Controlled Trials, clinical trial.gov, and Google Scholar were searched from 2019 to June 1, 2020. Additionally, the references of identified articles were also searched.

Results

A total of 9 articles comprising 3,823 patients were incorporated; 1416 patients on RAAS inhibitors and 3469 on non-RAAS inhibitors. The study demonstrated that the taking of RAAS inhibitors in COVID_19 patients with hypertension significantly reduced mortality where patients on RAAS inhibitors had a 27% decrease of mortality (RR = 0.73 [95% CI: 0.63- 0.85, p< 0.0001, I 2 = 0%, random-effects model]) compared to those not taking ACEI/ARB. No significant association were observed in disease severity (RR = 0.92 (95% CI: 0.74- 1.14) and hospitalization (WMD = –2.33[95% CI: –5.60, 0.75]), random-effects model.

Conclusion

This study supports RAAS inhibitors’ safe use among COVID_19 patients with hypertension.

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    SciScore for 10.1101/2020.09.03.20187393: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Search strategy: The databases such as PubMed, the Cochrane Central Register of controlled trials, clinical http://trial.gov, CINAHIL, and Google scholar were searched from 2019 to June 1, 2020.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Google scholar
    suggested: (Google Scholar, RRID:SCR_008878)
    Data analysis and statistical methods: Data analysis was performed by RevMan 5.4 (Copenhagen: the Cochrane Collaboration, 2020) and Stata version 13 (StataCorp, 2013).
    RevMan
    suggested: (RevMan, RRID:SCR_003581)
    Cochrane Collaboration
    suggested: None
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.09.03.20187393v1 on medRxiv