Renin-angiotensin system inhibitors not linked to COVID-19 severity, researchers conclude

The study’s findings support current guidelines for the treatment of hypertension during the COVID-19 pandemic.

Chinese woman having blood pressure taken

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Researchers found that although patients with hypertension had more severe presentations of COVID-19 than those without, there were no significant differences in disease severity according to ACEI or ARB use

Among people with hypertension, the severity of COVID-19 is not associated with the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), data from Wuhan, China, suggest (23 April 2020)[1]

The study, in JAMA Cardiology, was a case series of 1,178 patients with confirmed COVID-19 treated at a single hospital between 15 January 2020 and 15 March 2020. Overall, 362 (30.7%) patients had hypertension and 115 (31.8%) of these were taking ACEIs or ARBs.

The researchers found that patients with hypertension had more severe presentations of COVID-19 than those without and were more likely to die in hospital (21.3% vs 6.5%). However, in those with hypertension, there were no significant differences in the proportion of patients taking ACEIs or ARBs among those with severe and non-severe infections (32.9% vs 30.7%) or non-survivors and survivors (27.3% vs 33.0%).

The ACE2 receptor is used by the SARS-CoV-2 virus to gain access to cells, the researchers explained, but they said there were no previous data to indicate whether patients taking these drugs were at an increased risk of poor outcomes. Several organisations, including the American Heart Association, do not recommend switching drug treatment class in hypertension because of COVID-19.

“These data support current guidelines and societal recommendations for treating hypertension during the COVID-19 pandemic,” the researchers concluded.


[1] Li J, Wang X, Chen Jet al. Association of renin-angiotensin system inhibitors with severity or risk of death in patients with hypertension hospitalized for coronavirus disease 2019 (COVID-19) infection in Wuhan, China. JAMA Cardiol 2020. doi: 10.1001/jamacardio.2020.1624

Last updated
The Pharmaceutical Journal, PJ, June 2020, Vol 304, No 7938;304(7938):DOI:10.1211/PJ.2020.20207969

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