Arb vs acei
Pro Research Analysisby 
Searched over 200M research papers
Consensus Meter
Comparative Analysis of ARBs and ACEIs in COVID-19 Outcomes
Introduction to ARBs and ACEIs in COVID-19 Context
Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are commonly prescribed for managing hypertension and other cardiovascular conditions. With the onset of the COVID-19 pandemic, concerns emerged regarding the safety and efficacy of these medications due to their potential impact on ACE2 receptors, which SARS-CoV-2 uses to enter human cells . This article synthesizes current research to compare the effects of ARBs and ACEIs on COVID-19 susceptibility, severity, and mortality.
COVID-19 Susceptibility and ACEI/ARB Use
Several studies have investigated whether ACEI/ARB use increases the risk of contracting COVID-19. A systematic review and meta-analysis found no significant association between ACEI/ARB use and the risk of SARS-CoV-2 infection in the general population (adjusted OR 1.00, 95% CI 0.94-1.05). This finding is consistent across various populations and drug exposures, suggesting that ACEI/ARB use does not increase susceptibility to COVID-19 .
Impact on COVID-19 Severity
The severity of COVID-19 among patients using ACEIs or ARBs has been a critical area of research. Multiple studies indicate that ACEI/ARB use does not significantly affect the severity of COVID-19. For instance, a meta-analysis of East-Asian patients showed no statistically significant difference in disease severity between those receiving ACEI/ARB and those who were not (OR = 0.99, 95% CI 0.83-1.17). Similarly, another study found no increased risk of severe outcomes among COVID-19 patients taking these medications (aOR 0.95, 95% CI 0.73-1.24).
Mortality Rates and Clinical Outcomes
Research consistently shows that ACEI/ARB use is not associated with higher mortality rates in COVID-19 patients. In fact, some studies suggest a protective effect. A meta-analysis reported that ACEI/ARB use was associated with a lower mortality rate (OR = 0.61, 95% CI 0.52-0.70) and shorter hospital stays among East-Asian patients. Another study found that continued in-hospital use of ACEIs/ARBs was linked to significantly lower ICU admission and mortality rates compared to discontinuation of these medications.
Comparative Efficacy of ARBs vs. ACEIs
When comparing ARBs and ACEIs directly, some studies suggest that ARBs may offer a slight advantage in reducing mortality. A systematic review found that ARB use was associated with reduced mortality (OR 0.51, 95% CI 0.29-0.90), whereas ACEI use did not show a statistically significant reduction in mortality (OR 0.68, 95% CI 0.39-1.17). This finding aligns with another study that highlighted the blood pressure-independent benefits of ACEIs in reducing the risk of major coronary disease events, a benefit not observed with ARBs.
Conclusion
Current evidence supports the continued use of ACEIs and ARBs in patients with COVID-19, as these medications do not increase the risk of infection or severe outcomes. In fact, they may offer protective benefits, particularly in reducing mortality and ICU admissions. While both drug classes are effective, ARBs may have a slight edge in reducing mortality rates. Therefore, patients on these medications should continue their use under medical guidance, especially during the COVID-19 pandemic.
Sources and full results
Most relevant research papers on this topic