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. 2020 Jul 3;14(5):601–612. doi: 10.1007/s11684-020-0800-y

Use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in context of COVID-19 outbreak: a retrospective analysis

Jiuyang Xu 1,#, Chaolin Huang 2,#, Guohui Fan 3,4,5,#, Zhibo Liu 3,4,#, Lianhan Shang 3,4,6, Fei Zhou 3,4, Yeming Wang 3,4,7, Jiapei Yu 1, Luning Yang 1, Ke Xie 3,7, Zhisheng Huang 3,8, Lixue Huang 3,7, Xiaoying Gu 3,4,5, Hui Li 3,4, Yi Zhang 3,4, Yimin Wang 3,4, Frederick G Hayden 9, Peter W Horby 10, Bin Cao 3,4,7,11,✉, Chen Wang 3,4,11,12,✉
PMCID: PMC7333369  PMID: 32621202

Abstract

The possible effects of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) on COVID-19 disease severity have generated considerable debate. We performed a single-center, retrospective analysis of hospitalized adult COVID-19 patients in Wuhan, China, who had definite clinical outcome (dead or discharged) by February 15, 2020. Patients on anti-hypertensive treatment with or without ACEI/ARB were compared on their clinical characteristics and outcomes. The medical records from 702 patients were screened. Among the 101 patients with a history of hypertension and taking at least one anti-hypertensive medication, 40 patients were receiving ACEI/ARB as part of their regimen, and 61 patients were on antihypertensive medication other than ACEI/ARB. We observed no statistically significant differences in percentages of in-hospital mortality (28% vs. 34%, P = 0.46), ICU admission (20% vs. 28%, P = 0.37) or invasive mechanical ventilation (18% vs. 26%, P = 0.31) between patients with or without ACEI/ARB treatment. Further multivariable adjustment of age and gender did not provide evidence for a significant association between ACEI/ARB treatment and severe COVID-19 outcomes. Our findings confirm the lack of an association between chronic receipt of renin-angiotensin system antagonists and severe outcomes of COVID-19. Patients should continue previous anti-hypertensive therapy until further evidence is available.

Keywords: COVID-19, SARS-CoV-2, hypertension, angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker

Acknowledgements

We acknowledge all health-care workers involved in the diagnosis and treatment of patients in Jinyintan Hospital in Wuhan, China. This work was supported by Major Projects of National Science and Technology on New Drug Creation and Development (Nos. 2020ZX09201001 and 2020ZX09201012); Chinese Academy of Medical Sciences (CAMS) Emergency Project of COVID-19 (No. 2020HY320001).

Compliance with ethics guidelines

Dr. Frederick G. Hayden declares he has served as non-compensated consultant to Cidara, GlaxoSmithKline, Gilead Sciences, resTOR-bio, Regeneron, SAB Biotherapeutics on coronavirus interventions, outside the submitted work. All other authors declare no competing interests. The study was performed in accordance with the Helsinki Declaration of 1975, and was approved by the Research Ethics Commission of Jinyintan Hospital (KY-2020-01.01). Informed consent was waived by the Research Ethics Commission.

Footnotes

These authors contributed equally to this study.

Contributor Information

Bin Cao, Email: caobin_ben@163.com.

Chen Wang, Email: wangchen@pumc.edu.cn.

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