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. 2020 May 1;NEJMoa2008975.
doi: 10.1056/NEJMoa2008975. Online ahead of print.

Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Covid-19

Free PMC article

Renin-Angiotensin-Aldosterone System Inhibitors and Risk of Covid-19

Harmony R Reynolds et al. N Engl J Med. .
Free PMC article


Background: There is concern about the potential of an increased risk related to medications that act on the renin-angiotensin-aldosterone system in patients exposed to coronavirus disease 2019 (Covid-19), because the viral receptor is angiotensin-converting enzyme 2 (ACE2).

Methods: We assessed the relation between previous treatment with ACE inhibitors, angiotensin-receptor blockers, beta-blockers, calcium-channel blockers, or thiazide diuretics and the likelihood of a positive or negative result on Covid-19 testing as well as the likelihood of severe illness (defined as intensive care, mechanical ventilation, or death) among patients who tested positive. Using Bayesian methods, we compared outcomes in patients who had been treated with these medications and in untreated patients, overall and in those with hypertension, after propensity-score matching for receipt of each medication class. A difference of at least 10 percentage points was prespecified as a substantial difference.

Results: Among 12,594 patients who were tested for Covid-19, a total of 5894 (46.8%) were positive; 1002 of these patients (17.0%) had severe illness. A history of hypertension was present in 4357 patients (34.6%), among whom 2573 (59.1%) had a positive test; 634 of these patients (24.6%) had severe illness. There was no association between any single medication class and an increased likelihood of a positive test. None of the medications examined was associated with a substantial increase in the risk of severe illness among patients who tested positive.

Conclusions: We found no substantial increase in the likelihood of a positive test for Covid-19 or in the risk of severe Covid-19 among patients who tested positive in association with five common classes of antihypertensive medications.


Figure 1
Figure 1. Patient Population.
Patients were deemed to be positive for coronavirus disease 2019 (Covid-19) if any test was positive for SARS-CoV-2 RNA and negative for Covid-19 if all tests were negative. An unstructured result meant that the data extraction algorithm could not identify the result, because it was scanned into the electronic health record rather than entered as discrete data. Severe Covid-19 was defined as admission to the intensive care unit, the use of noninvasive or invasive mechanical ventilation, or death. NYU denotes New York University.

Comment in

  • N Engl J Med. doi: 10.1056/NEJMe2012924

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