Is the use of ACE inb/ARBs associated with higher in-hospital mortality in Covid-19 pneumonia patients?

Clin Exp Hypertens. 2020 Nov 16;42(8):738-742. doi: 10.1080/10641963.2020.1783549. Epub 2020 Jun 22.


Introduction: The present research aimed to determine the relation between the use of angiotensin-converting enzyme inhibitors (ACE inh) and angiotensinogen receptor blockers (ARBs) and in-hospital mortality of hypertensive patients diagnosed with Covid-19 pneumonia.

Material and method: In this retrospective study, we included 113 consecutive hypertensive patients admitted due to Covid-19 infection. In all patients, Covid-19 infection was confirmed with using reverse-transcription polymerase chain reaction. All patients were on ACE inh/ARBs or other antihypertensive therapy unless no contraindication was present. The primary outcome of the study was the in-hospital all-cause mortality.

Results: In total, 113 hypertensive Covid-19 patients were included, of them 74 patients were using ACE inh/ARBs. During in-hospital follow up, 30.9% [n = 35 patients] of patients died. The frequency of admission to the ICU and endotracheal intubation were significantly higher in patients using ACE inh/ARBs. In a multivariable analysis, the use of ACE inh/ARBs was an independent predictor of in-hospital mortality (OR: 3.66; 95%CI: 1.11-18.18; p= .032). Kaplan-Meir curve analysis displayed that patients on ACE inh/ARBs therapy had higher incidence of in-hospital death than those who were not.

Conclusion: The present study has found that the use of ACE inh/ARBs therapy might be associated with an increased in-hospital mortality in patients who were diagnosed with Covid-19 pneumonia. It is likely that ACE inh/ARBs therapy might not be beneficial in the subgroup of hypertensive Covid-19 patients despite the fact that there might be the possibility of some unmeasured residual confounders to affect the results of the study.

Keywords: ACE inh/ARBs; Covid-19; SARSCoV-2; mortality.

MeSH terms

  • Aged
  • Angiotensin Receptor Antagonists / adverse effects*
  • Angiotensin-Converting Enzyme Inhibitors / adverse effects*
  • Betacoronavirus*
  • Coronavirus Infections / mortality*
  • Female
  • Hospital Mortality
  • Hospitalization
  • Humans
  • Hypertension / drug therapy*
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / mortality*
  • Retrospective Studies


  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2