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Open AccessArticle

Mortality, Severity, and Hospital Admission among COVID-19 Patients with ACEI/ARB Use: A Meta-Analysis Stratifying Countries Based on Response to the First Wave of the Pandemic

1
Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, 1295 N Martin Ave, Tucson, AZ 85721, USA
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Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
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Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahasa 31982, Saudi Arabia
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Pharmaceutical Service Department, Main Hospital, King Fahad Medical City, Riyadh 11564, Saudi Arabia
5
Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA
*
Author to whom correspondence should be addressed.
Academic Editors: Emanuele Amodio and Palmira Immordino
Healthcare 2021, 9(2), 127; https://doi.org/10.3390/healthcare9020127
Received: 25 December 2020 / Revised: 22 January 2021 / Accepted: 26 January 2021 / Published: 28 January 2021
Background: The use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) is controversial for treating COVID-19 patients. We aimed to estimate pooled risks of mortality, disease severity, and hospitalization associated with ACEI/ARB use and stratify them by country and country clusters. Methods: We conducted a search in various databases through 4 July 2020 and then applied random-effects models to estimate pooled risks (ORp) across stratifications by country cluster. Clusters were chosen to reflect outbreak times (China followed by Korea/Italy, others subsequently) and mobility restrictions (China and Denmark/France/Spain with stricter lockdowns than the UK/US). Results: Overall analysis showed no increase in mortality; however, a statistical increase in mortality was seen in the US/UK cluster with ORp = 1.28 [95% CI = 1.04; 1.56] and a decrease in China with ORp = 0.65 [95% CI = 0.43; 0.96] and France with OR = 0.31 [95% CI = 0.14; 0.69]. Severity and hospitalization were not statistically significant in the analysis; however, several associations were seen in specific countries but not in country clusters. Conclusion: The country-cluster meta-analysis provided a reasonable explanation for COVID-19 mortality among ACEI/ARB users. The analysis did not explain differences in severity and suggested the involvement of other factors. Hospitalization findings among ACEI/ARB users may be considered informative as they may have been subjected to clinical decisions and hospital-bed availability. View Full-Text
Keywords: angiotensin-converting enzyme inhibitor; angiotensin II receptor blocker; Covid-19; mortality; disease severity; hospital admission angiotensin-converting enzyme inhibitor; angiotensin II receptor blocker; Covid-19; mortality; disease severity; hospital admission
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MDPI and ACS Style

Alamer, A.A.; Almulhim, A.S.; Alrashed, A.A.; Abraham, I. Mortality, Severity, and Hospital Admission among COVID-19 Patients with ACEI/ARB Use: A Meta-Analysis Stratifying Countries Based on Response to the First Wave of the Pandemic. Healthcare 2021, 9, 127. https://doi.org/10.3390/healthcare9020127

AMA Style

Alamer AA, Almulhim AS, Alrashed AA, Abraham I. Mortality, Severity, and Hospital Admission among COVID-19 Patients with ACEI/ARB Use: A Meta-Analysis Stratifying Countries Based on Response to the First Wave of the Pandemic. Healthcare. 2021; 9(2):127. https://doi.org/10.3390/healthcare9020127

Chicago/Turabian Style

Alamer, Ahmad A.; Almulhim, Abdulaziz S.; Alrashed, Ahmed A.; Abraham, Ivo. 2021. "Mortality, Severity, and Hospital Admission among COVID-19 Patients with ACEI/ARB Use: A Meta-Analysis Stratifying Countries Based on Response to the First Wave of the Pandemic" Healthcare 9, no. 2: 127. https://doi.org/10.3390/healthcare9020127

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