- neither ACE inhibitors nor angiotensin-receptor blockers were associated with in-hospital risk of death

University of California, Berkeley

Inhibitors of the Renin-Angiotensin-Aldosterone pathway (ie. ACE inhibitors, angiotensin-receptor blockers) are commonly used to treat hypertension. Previous animal studies, which have shown that these inhibitors can increase the level of ACE2 expression in one's body, coupled with the cardiovascular comorbidities, lead to speculation amongst clinicians and researchers that these widely-used drugs may be harmful for patients with COVID-19. Current studies (June 2020) have shown no evidence of harm with continued use of RAAS inhibitors in COVID-19 patients. 

- database study involving 8910 patients from 11 countries
- case control study in the Lombardy region of Italy
- study based on data from the electronic health records in the New York University Langone Health system


Inhibitors of the Renin–Angiotensin–Aldosterone System (RAAS) and COVID-19

Mandeep R. Mehra, M.D., Sapan S. Desai, M.D., Ph.D., SreyRam Kuy, M.D., M.H.S., Timothy D. Henry, M.D., and Amit N. Patel, M.D. Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19. N Engl J Med 2020; 382:e102 (June 2020) DOI: 10.1056/NEJMoa2007621
https://www.nejm.org/doi/full/10.1056/NEJMoa2007621

Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19


Database study involving 8910 patients from 11 countries

- neither ACE inhibitors nor angiotensin-receptor blockers were associated with severe COVID-19 (conditional logistic-regression multivariate analysis)

Case control study in the Lombardy region of Italy

- neither ACE inhibitors nor angiotensin-receptor blockers were positively associated with a positive test result or severe COVID-19

Study based on data from the electronic health records in the New York University Langone Health system

Because ACE and ACE2 are structurally similar, it was thought that existing ACE inhibitor (ACE-I) drugs could be used as a COVID-19 treatment by inhibiting ACE2 activity.  However, because the enzymatic binding sites of ACE and ACE2 are different, ACE-Is do not affect ACE2 activity.  Additionally, COVID-19 patients who took ACE-I drugs were more likely to experience more severe symptoms and had a higher mortality rate than those that didn't take them.  It is thought that ACE inhibition in the RAS may exacerbate the vulnerability of patients with hypertension, diabetes mellitus, or cardiovascular disease to SARS-CoV-2 infection or COVID-19 symptoms.

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