Efeito protetor do uso de bloqueadores de receptores de angiotensina 2 contra desfechos graves da COVID-19 em pacientes hipertensos: revisão sistemática com metanálise

Abstract

There are several records in the literature that show the non-association between the use of antihypertensive drugs that inhibit the action of angiotensin II (ANGII) and the occurrence of serious outcomes of COVID-19 in hypertensive patients, which suggests that these drugs potentially exert a protective effect. However, there are no studies in the literature that have investigated this potential considering in an isolated way the effect of different classes of these antihypertensive drugs. Analyse if the use of ANGII type I receptor inhibitors (ARBs) is more protective than that of Angiotensin I Converting Enzyme (ACEi) inhibitors against critical COVID-19 outcomes in hypertensive patients. A systematic review was carried out with a random effect meta-analysis, following the PRISMA model (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes), and using the PubMed, Lilacs and Scielo platforms to collect papers. Twelve of 122 studies were selected, totaling 130,243 patients. In the data analysis, treatment with ARB was considered as intervention/exposure and treatment with ACEI as control/non-exposure. The I2 statistic was used to measure the heterogeneity among the selected works. The results show that, although statistically it is not possible to prove the hypothesis, the summary statistics show a clear trend of: greater hospital admission of patients using ACEI (Standardized Mean Deviation [SMD]: -0.16, interval of 95% confidence [95%CI]: -0.34 to 0.01); higher number of ICU admissions of patients using ACEI (DMP: -0.28, 95%CI: -0.63 to 0.06); higher number of deaths of patients using ACE inhibitors (DMP: -0.15, 95%CI: -0.39 to 0.08). It was not possible to associate concomitant deaths with critical events with the use of ARBs or ACEIs (DMP: -0.10, 95%CI: -0.37 to 0.17). Statistically, it was not possible to associate, in an isolated way, the use of antihypertensive drugs that inhibit the action of ANGII with the protective effect against serious outcomes reported in the literature. However, it was possible to observe a protective tendency for the use of ARBs.