The spreading epidemic of novel coronavirus (corona virus disease 2019, COVID-19) pneumonia poses a serious challenge to global life health and disease control, with significantly higher mortality rates among individuals infected with COVID-19 comorbid underlying disease. Inhibitors of the rennin-angiotensin-aldosterone system (RAASi) , an important class of anti-hypertensive drugs, have been found to increase the morbidity and mortality of COVID-19. This study aimed to clarify the efficacy and safety of RAASi treatment in COVID-19 patients with hypertension.

To systematically evaluate the efficacy and safety of RAASi therapy in COVID-19 patients with hypertension.

PubMed, Embase, Cochrane Library and China National Knowledge Infrastructure (CNKI) were searched from inception to January 2022. A publicly available case-control studies of COVID-19 patients with hypertension treated with RAASi versus non RAASi therapy were included, and outcome measures were overall mortality, incidence of critical illness, incidence of acute respiratory distress syndrome (ARDS) , incidence of myocardial injury, and incidence of renal injury, with meta-analysis performed using Revman 5.3.

Seventeen studies with a total of 5 689 patients were included, of whom 2 168 received RAASi therapy and 3 521 did not. Meta analysis showed that overall mortality was lower in COVID-19 comorbid hypertensive patients treated with RAASi compared with non RAASi treated patients 〔OR=0.54, 95%CI (0.41, 0.72) , P<0.000 1〕; Between RAASi treated and non RAASi treated COVID-19 patients associated with hypertension, the incidence of critical illness 〔OR=0. 92, 95%CI (0.79, 1.08) , P=0.30〕, the incidence of ARDS 〔OR=0.81, 95%CI (0.57, 1.13, P=0.22〕, the incidence of myocardial injury 〔OR=1.03, 95%CI (0.83, 1.27) , P=0.82〕, and the incidence of kidney injury 〔OR=1.13, 95%CI (0.78, 1.66) , P=0.52〕, differences were not statistically significant.

Treatment with RAASi in COVID-19 patients with hypertension reduced the overall mortality rate, and did not increase the incidence of critical illness, ARDS, myocardial injury, and renal injury in COVID-19 patients with hypertension. RAASi therapy is effective and safe in treating patients with COVID-19 combined with hypertension.

新型冠状病毒肺炎（COVID-19）的蔓延流行给全球生命健康及疾病防治带来了严峻挑战，COVID-19合并基础疾病患者的死亡率明显增高。肾素-血管紧张素-醛固酮系统抑制剂（RAASi）是一类重要的抗高血压药，研究发现RAASi可能增加COVID-19患者的发病率与死亡率，本研究旨在明确RAASi治疗COVID-19合并高血压患者的有效性与安全性。

系统评价RAASi治疗COVID-19合并高血压患者的有效性与安全性。

检索PubMed、Embase、Cochrane Library及中国知网（CNKI），检索时间为建库至2022年1月。纳入公开发表的、采用RAASi治疗与非RAASi治疗的COVID-19合并高血压患者的病例对照研究，结局指标为总体死亡率、危重症发生率、急性呼吸窘迫综合征（ARDS）发生率、心肌损伤发生率、肾损伤发生率，采用RevMan 5.3软件进行Meta分析。

纳入的17项研究共包含5 689例患者，其中2 168例接受了RAASi治疗（RAASi治疗组），3 521例未接受RAASi治疗（非RAASi治疗组）。Meta分析结果显示：RAASi治疗组COVID-19合并高血压患者总体死亡率低于非RAASi治疗组〔OR=0.54，95%CI（0.41，0.72），P<0.000 1〕；RAASi治疗组与非RAASi治疗组COVID-19合并高血压患者危重症发生率〔OR=0.92，95%CI（0.79，1.08），P=0.30〕、ARDS发生率〔OR=0.81，95%CI（0.57，1.13），P=0.22〕、心肌损伤发生率〔OR=1.03，95%CI（0.83，1.27），P=0.82〕、肾脏损伤发生率〔OR=1.13，95%CI（0.78，1.66），P=0.52〕比较，差异均无统计学意义。

RAASi治疗COVID-19合并高血压患者可降低总体死亡率，且不增加COVID-19合并高血压患者危重症、ARDS、心肌损伤及肾脏损伤发生率，具有较好的疗效和安全性。