Bianca de Almeida‑Pititto1,2,3*, Patrícia M. Dualib2,3,4, Lenita Zajdenverg2,5, Joana Rodrigues Dantas5,
Filipe Dias de Souza3, Melanie Rodacki2,5 and Marcello Casaccia Bertoluci2,6,7 on behalf of Brazilian Diabetes
Society Study Group (SBD)
Abstract
Background: The aim of this study is to evaluate the impact of diabetes, hypertension, cardiovascular disease and
the use of angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) with severity (invasive
mechanical ventilation or intensive care unit admission or O2 saturation < 90%) and mortality of COVID-19 cases.
Methods: Systematic review of the PubMed, Cochrane Library and SciELO databases was performed to identify relevant
articles published from December 2019 to 6th May 2020. Forty articles were included involving 18.012 COVID-
19 patients.
Results: The random-effect meta-analysis showed that diabetes mellitus and hypertension were moderately associated
respectively with severity and mortality for COVID-19: Diabetes [OR 2.35 95% CI 1.80–3.06 and OR 2.50 95% CI
1.74–3.59] Hypertension: [OR 2.98 95% CI 2.37–3.75 and OR 2.88 (2.22–3.74)]. Cardiovascular disease was strongly associated
with both severity and mortality, respectively [OR 4.02 (2.76–5.86) and OR 6.34 (3.71–10.84)]. On the contrary,
the use of ACEI/ARB, was not associate with severity of COVID-19.
Conclusion: In conclusion, diabetes, hypertension and especially cardiovascular disease, are important risk factors for
severity and mortality in COVID-19 infected people and are targets that must be intensively addressed in the management
of this infection.
Keywords: Diabetes, Hypertension, Cardiovascular disease, COVID-19, SARS-CoV-2, Severity, Mortality
Background: The aim of this study is to evaluate the impact of diabetes, hypertension, cardiovascular disease and
the use of angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) with severity (invasive
mechanical ventilation or intensive care unit admission or O2 saturation < 90%) and mortality of COVID-19 cases.
Methods: Systematic review of the PubMed, Cochrane Library and SciELO databases was performed to identify relevant
articles published from December 2019 to 6th May 2020. Forty articles were included involving 18.012 COVID-
19 patients.
Results: The random-effect meta-analysis showed that diabetes mellitus and hypertension were moderately associated
respectively with severity and mortality for COVID-19: Diabetes [OR 2.35 95% CI 1.80–3.06 and OR 2.50 95% CI
1.74–3.59] Hypertension: [OR 2.98 95% CI 2.37–3.75 and OR 2.88 (2.22–3.74)]. Cardiovascular disease was strongly associated
with both severity and mortality, respectively [OR 4.02 (2.76–5.86) and OR 6.34 (3.71–10.84)]. On the contrary,
the use of ACEI/ARB, was not associate with severity of COVID-19.
Conclusion: In conclusion, diabetes, hypertension and especially cardiovascular disease, are important risk factors for
severity and mortality in COVID-19 infected people and are targets that must be intensively addressed in the management
of this infection.
Keywords: Diabetes, Hypertension, Cardiovascular disease, COVID-19, SARS-CoV-2, Severity, Mortality