Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension

Emerg Microbes Infect. 2020 Dec;9(1):757-760. doi: 10.1080/22221751.2020.1746200.


The dysfunction of the renin-angiotensin system (RAS) has been observed in coronavirus infection disease (COVID-19) patients, but whether RAS inhibitors, such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs), are associated with clinical outcomes remains unknown. COVID-19 patients with hypertension were enrolled to evaluate the effect of RAS inhibitors. We observed that patients receiving ACEI or ARB therapy had a lower rate of severe diseases and a trend toward a lower level of IL-6 in peripheral blood. In addition, ACEI or ARB therapy increased CD3 and CD8 T cell counts in peripheral blood and decreased the peak viral load compared to other antihypertensive drugs. This evidence supports the benefit of using ACEIs or ARBs to potentially contribute to the improvement of clinical outcomes of COVID-19 patients with hypertension.

Keywords: COVID-19; Renin-angiotensin system; angiotensin II type1 receptor blockers; angiotensin-converting enzyme inhibitors; hypertension.

Publication types

  • Letter

MeSH terms

  • Aged
  • Angiotensin II Type 1 Receptor Blockers / therapeutic use*
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Antihypertensive Agents / therapeutic use*
  • Betacoronavirus
  • C-Reactive Protein / analysis
  • CD3 Complex
  • CD8-Positive T-Lymphocytes / cytology
  • COVID-19
  • COVID-19 Drug Treatment
  • China
  • Coronavirus Infections / complications*
  • Coronavirus Infections / drug therapy
  • Female
  • Humans
  • Hypertension / complications
  • Hypertension / drug therapy*
  • Hypertension / virology
  • Interleukin-6 / blood
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / drug therapy
  • Renin-Angiotensin System*
  • Retrospective Studies
  • SARS-CoV-2
  • Treatment Outcome
  • Viral Load


  • Angiotensin II Type 1 Receptor Blockers
  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • CD3 Complex
  • IL6 protein, human
  • Interleukin-6
  • C-Reactive Protein

Grants and funding

This work was supported by the National Natural Science Foundation of China (No. 81873958), the China Postdoctoral Science Foundation (No. 2019M653108), the National Science and Technology Major Project for Control and Prevention of Major Infectious Diseases of China (No. 2017ZX10103004), the State Key Laboratory of Respiratory Diseases Open Project (No. SKLRD-OP-201919), and the Sanming Project of Medicine in Shenzhen (No. SZSM201911009).