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

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 mortality, disease severity, and hospitalization associated with ACEI/ARB stratify them by country clusters. Methods: conducted a search in various databases through 4 July 2020 then applied random-effects models (ORp) across stratifications cluster. Clusters were chosen reflect outbreak times (China followed Korea/Italy, others subsequently) mobility restrictions Denmark/France/Spain stricter lockdowns than the UK/US). Results: Overall analysis showed no increase mortality; however, statistical mortality was seen US/UK cluster ORp = 1.28 [95% CI 1.04; 1.56] decrease China 0.65 0.43; 0.96] France OR 0.31 0.14; 0.69]. Severity not statistically significant analysis; several associations specific countries but Conclusion: country-cluster meta-analysis provided reasonable explanation among users. did explain differences severity suggested involvement other factors. Hospitalization findings users may be considered informative as they have been subjected clinical decisions hospital-bed availability.