The aim of this study was to continually evaluate the association between cardiovascular drug exposure and COVID-19 clinical outcomes (susceptibility to infection, disease severity, hospitalization, hospitalization length, and all-cause mortality) in patients at risk of/with confirmed COVID-19.
Eligible publications were identified from more than 500 databases on 1 November 2020. One reviewer extracted data with 20% of the records independently extracted/evaluated by a second reviewer.
Of 52 735 screened records, 429 and 390 studies were included in the qualitative and quantitative syntheses, respectively. The most-reported drugs were angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) with ACEI/ARB exposure having borderline association with confirmed COVID-19 infection (OR 1.14, 95% CI 1.00–1.31). Among COVID-19 patients, unadjusted estimates showed that ACEI/ARB exposure was associated with hospitalization (OR 1.76, 95% CI 1.34–2.32), disease severity (OR 1.40, 95% CI 1.26–1.55) and all-cause mortality (OR 1.22, 95% CI 1.12–1.33) but not hospitalization length (mean difference −0.27, 95% CI −1.36–0.82 days). After adjustment, ACEI/ARB exposure was not associated with confirmed COVID-19 infection (OR 0.92, 95% CI 0.71–1.19), hospitalization (OR 0.93, 95% CI 0.70–1.24), disease severity (OR 1.05, 95% CI 0.81–1.38) or all-cause mortality (OR 0.84, 95% CI 0.70–1.00). Similarly, subgroup analyses involving only hypertensive patients revealed that ACEI/ARB exposure was not associated with confirmed COVID-19 infection (OR 0.93, 95% CI 0.79–1.09), hospitalization (OR 0.84, 95% CI 0.58–1.22), hospitalization length (mean difference −0.14, 95% CI −1.65–1.36 days), disease severity (OR 0.92, 95% CI 0.76–1.11) while it decreased the odds of dying (OR 0.76, 95% CI 0.65–0.88). A similar trend was observed for other cardiovascular drugs. However, the validity of these findings is limited by a high level of heterogeneity and serious risk of bias.
Cardiovascular drugs are not associated with poor COVID-19 outcomes in adjusted analyses. Patients should continue taking these drugs as prescribed