Title:Pre-Admission Beta-Blocker Therapy and Outcomes of Coronavirus
Disease 2019 (COVID-19): A Systematic Review, Meta-Analysis, and
Meta-Regression
Volume: 22
Issue: 2
Author(s): Timotius Ivan Hariyanto, Joshua Edward Hananto, Denny Intan and Andree Kurniawan*
Affiliation:
- Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Boulevard Jendral
Sudirman Street, Karawaci, Tangerang 15811, Indonesia
Keywords:
Coronavirus disease 2019, beta-blocker, hypertension, heart failure, cardiovascular, treatment.
Abstract:
Background: Hypertension and heart failure are known risk factors for coronavirus
disease 2019 (COVID-19) severity and mortality outcomes. Beta-blocker is one of the drugs of
choice to treat these conditions. The purpose of this study is to explore the relationship between preadmission
beta-blocker use and COVID-19 outcomes.
Methods: PubMed and Europe PMC were used as the database for our search strategy by using
combined keywords related to our aims until December 10th, 2020. All articles related to COVID-
19 and beta-blocker were retrieved. Review Manager 5.4 and Comprehensive Meta-Analysis 3
software were used to perform statistical analysis.
Results: A total of 43 studies consisting of 11,388,556 patients were included in our analysis. Our
meta-analysis showed that the use of beta-blocker was associated with increased risk of COVID-19
[OR 1.32 (95% CI 1.02 - 1.70), p = 0.03, I2 = 99%, random-effect modelling], clinical progression
[OR 1.37 (95% CI 1.01 - 1.88), p = 0.04, I2 = 89%, random-effect modelling], and mortality from
COVID-19 [OR 1.64 (95% CI 1.22 - 2.19), p = 0.0009, I2 = 94%, random-effect modelling]. Metaregression
showed that the association with mortality outcome were influenced by age (p = 0.018)
and hypertension (p = 0.005).
Conclusion: The risk and benefits of using beta-blocker as a drug of choice to treat hypertensive
patients should be considered and reviewed individually, case by case, knowing their association
with higher incidence and severity of COVID-19 infections. Other first-line antihypertensive drugs
may be considered as an alternative therapy if the risk of administering beta blockers outweighs the
benefits of COVID-19 infection. Registration details: PROSPERO (CRD42021260455).