meta|Evidence - COVID-19
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losartan (n=101) vs. placebo (n=104)
randomized controlled trial some concerns about risk of bias
losartan for 7 days or hospital discharge
Losartan 50 mg PO twice daily (100 mg daily total) administered for 10 days.
placebo for 7 days or hospital discharge
placebo (microcrystalline methylcellulose, gelatin capsule); oral administration
COVID 19 all comers
18 years and older with presumptive positive laboratory test for SARS-coV-2 or upper respiratory infection with recent exposure to laboratory-proven SARS-coV-2-infected person�negative influenza and respiratory virus panel�new or worsening hypoxia (spO2 <95%) compared to baseline or increasing oxygen requirement�randomization within 24 hours of initial presentation to a hospital (inclusive of transfer)exclusion criteria:�currently taking an angiotensin converting enzyme inhibitor (ACei) or angiotensin receptor blocker (ARB)�prior reaction or intolerance to an ARB or ACei
Double-blind.
Multi-center: 13 hospitals in the United States.
Participants discharged prior to day 7 were provided a home pulse oximeter and contacted via phone.
angiotensin receptor blockers (ARBs) (n=41) vs. calcium channel blocker (n=41)
randomized controlled trial some concerns about risk of bias
Losartan
Losartan 25mg twice a day for two weeks before breakfast and after dinner.
Amlodipine
Amlodipine 5mg per day for two weeks.
Standard treatment, supportive and symptomatic therapy in both groups. In intubated patients, the drugs were continued using nasogastric tube.
COVID 19 hospitalized
Age 18 years and older, patients with primary HTN with systolicblood pressure (SBP) level of 130-140 mmHg and diastolic blood pressure (DBP) of 85-90 mmHgwho were managed by non-pharmacological strategies or were newly diagnosed.
Open-label.
Single center, Imam Reza Hospital, Tabriz, Iran.
angiotensin receptor blockers (ARBs) (n=41) vs. standard of care (n=41)
randomized controlled trial high risk of bias
Telmisartan
Telmisartan 80 mg bid during 14 days plus standard care.
Standard care
Standard of care alone.
COVID 19 hospitalized
Patients admitted in ICU prior to randomization were excluded.
Open-label.
Multicenter, 2 academic hospitals, Buenos Aires, Argentina.
unplanned interim anakysis
discontinuation of ACEI/ARB (n=77) vs. continuation of ACEI/ARB (n=75)
randomized controlled trial risk of bias NA
discontinue ACEI or ARB therapy
continue ACEI or ARB therapy
COVID 19 hospitalized
open-label
20 large referral hospitals in seven countries worldwide
discontinuation of ACEI/ARB (n=371) vs. continuation of ACEI/ARB (n=369)
randomized controlled trial some concerns about risk of bias
Discontinuation of ACEIs or ARBs
Other drugs could replace these agents at the discretion of the treating physician.β-Blockers were maintained in patients already taking them for heart failure.
Continuation of ACEIs or ARBs
The study protocol did not recommend any specific treatment modification beyond discontinuing or continuing use of ACEIs or ARBs.
COVID-19 mild to moderate
Hospitalized patients with confirmed COVID-19 diagnosis, using ACEI or ARBs; Age ≥18 years; Using no more than 3 antihypertensive drugs; Ability of patient (or legal representative) to provide informed consent.
Open-label.
Multicenter, 29 sites in Brazil.
Outcome calculated for each patient by subtracting the number of days in the hospital and the number of days from death until the end of follow-up from 30 days.
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