Since the 2019 coronavirus disease (COVID-19) emerged, there has been discussion among health care professionals about the role of ACE-inhibitors (ACEIs) and ARBs. This has been of concern knowing that hypertension is one of the comorbidities that appears to predispose patients to the development of more severe disease.

Coronaviruses are known to utilize the ACE2 to help facilitate entry into the host target cell. Some were concerned that this may help promote infection, as ACE2 is known to be upregulated in patients taking ACEIs and ARBs. On the other hand, laboratory data dating back to other coronaviruses suggested that ACEIs and ARBs may be protective against the virus by helping to block viral entry. It has also been suggested that changes in the renin-angiotensin system contribute to the pathogenesis of the inflammatory lung disease caused by the virus and that these drugs could potentially have a role in reducing damage to the lung tissue. Most of the debate has been based on theory because there was minimal clinical data available to evaluate the potential benefit or risk of these medications.

A new study published ahead of print in Emerging Microbes & Infections provides the first clinical data regarding patients with COVID-19 and the impact of these medications. The retrospective study of Chinese patients hospitalized with COVID-19 from January 11, 2020 to February 23, 2020 evaluated the records of 42 patients taking antihypertensives. Of these patients, 17 were taking ACEIs or ARBs and the remaining 25 were treated with other antihypertensives that included calcium channel blockers, beta-blockers, and diuretics. Most of the patients studied had been on antihypertensive therapy for at least 1 year prior to becoming infected. The average age was 64.5 years, and 57.1% of patients were male. Overall, the baseline characteristics between the 2 groups were similar.

Patients in the non-ACEI/ARB group had higher rates of severe infection (48 % [n=12] vs. 23.5% [n=4]). The difference was not significant, but the overall enrollment numbers of the study were small. Patients receiving ACEIs and ARBs were also noted to have lower IL-6 levels, higher CD3+ and CD8+ T cells, and significantly lower peak viral load than the patients receiving other antihypertensives. Finally, the only death occurred in a patient in the non-ACEI/ARB group.

While it may be too early to make definitive conclusions about the impact of ACEI and ARBs on COVID-19 severity or protection, this study provides the first insight into real-world clinical outcomes of infected patients taking these medications. Though more data is needed to determine a correlation, the results of the study are encouraging and may lend support to those advocating for the continued use of ACEI and ARBs for hypertension in the setting of this unprecedented pandemic.


Meng J, Xiao G, Shang J. Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension. Emerg Microbes Infect. 2020;9:7575-760