Comorbidities in COVID-19: Outcomes in hypertensive cohort and controversies with renin angiotensin system blockers

Diabetes Metab Syndr. Jul-Aug 2020;14(4):283-287. doi: 10.1016/j.dsx.2020.03.016. Epub 2020 Apr 9.


Background and aims: COVID-19 is already a pandemic. Emerging data suggest an increased association and a heightened mortality in patients of COVID-19 with comorbidities. We aimed to evaluate the outcome in hypertensive patients with COVID-19 and its relation to the use of renin-angiotensin system blockers (RASB).

Methods: We have systematically searched the medical database up to March 27, 2020 and retrieved all the published articles in English language related to our topic using MeSH key words.

Results: From the pooled data of all ten available Chinese studies (n = 2209) that have reported the characteristics of comorbidities in patients with COVID-19, hypertension was present in nearly 21%, followed by diabetes in nearly 11%, and established cardiovascular disease (CVD) in approximately 7% of patients. Although the emerging data hints to an increase in mortality in COVID-19 patients with known hypertension, diabetes and CVD, it should be noted that it was not adjusted for multiple confounding factors. Harm or benefit in COVID-19 patients receiving RASB has not been typically assessed in these studies yet, although mechanistically and plausibly both, benefit and harm is possible with these agents, given that COVID-19 expresses to tissues through the receptor of angiotensin converting enzyme-2.

Conclusion: Special attention is definitely required in patients with COVID-19 with associated comorbidities including hypertension, diabetes and established CVD. Although the role of RASB has a mechanistic equipoise, patients with COVID-19 should not stop these drugs at this point of time, as recommended by various world organizations and without the advice of health care provider.

Keywords: Angiotensin-converting enzyme inhibitors; Angiotensin-receptor blockers; COVID-19; Comorbidities; Hypertension.

Publication types

  • Systematic Review

MeSH terms

  • Angiotensin Receptor Antagonists / adverse effects
  • Angiotensin Receptor Antagonists / therapeutic use
  • Angiotensin-Converting Enzyme 2
  • Angiotensin-Converting Enzyme Inhibitors / adverse effects
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Animals
  • Antihypertensive Agents / adverse effects
  • Antihypertensive Agents / therapeutic use*
  • Betacoronavirus*
  • COVID-19
  • Cardiovascular Diseases / epidemiology
  • China / epidemiology
  • Comorbidity*
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / mortality
  • Diabetes Mellitus / epidemiology
  • Humans
  • Hypertension / drug therapy*
  • Hypertension / epidemiology
  • Mice
  • Pandemics
  • Peptidyl-Dipeptidase A / physiology
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / mortality
  • PubMed
  • Renin-Angiotensin System / drug effects*
  • Renin-Angiotensin System / physiology
  • SARS-CoV-2


  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Peptidyl-Dipeptidase A
  • ACE2 protein, human
  • Ace2 protein, mouse
  • Angiotensin-Converting Enzyme 2