Association of Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use With COVID-19 Diagnosis and Mortality

Prognosis Cardiology and metabolic diseasesInfectiology
Fosbøl EL et al

Main result

  •     In the retrospective cohort study, 4,480 patients with COVID-19 were included (median age, 54.7 years; 47.9% male). There were 895 patients on ACE inhibitors or ARBs (20.0%) and 3585 non-users (80.0%).

        Primary endpoint: death within 30 days for 18.1% of patients in the ACE inhibitor/ARB group vs. 7.3% in the non-user group, but association not significant after adjustment for age, sex and medical history (adjusted risk ratio [HR], 0.83 [95% CI: 0.67-1.03]).

        Secondary endpoint: death or severe IDVOC-19 at 30 days occurred in 31.9% of patients in the ACE/ARA group versus 14.2% of non-users (adjusted HR 1.04 [95% CI 0.89-1.23]).

  •     In the nested case-control analysis, 571 hypertensive patients with COVID-19 (median age, 73.9 years; 54.3% males) were compared with 5,710 age- and sex-matched non COVID-19 hypertensive controls. Among COVID-19 hypertensive patients, 86.5% were on ACE inhibitor/ARB compared to 85.4% of non-COVID-19 hypertensive patients;

         The use of ACE inhibitor/ARB compared to other antihypertensive agents was not significantly associated with a higher incidence of COVID-19 (adjusted HR 1.05 [95% CI 0.80-1.36]).


Among patients diagnosed with COVID-19, this study found no significant association between prior ACE inhibitor use and mortality or severe COVID-19 after adjustment for baseline demographics and co-morbidities.

In sensitivity analyses, the use of ACE inhibitors/ARAs was not associated with a higher incidence of COVID-19 diagnosis compared to users of other antihypertensive drugs.

Strength of evidence Weak

Observational study
Retrospective Danish population-wide cohort study, n=4,480.
Case-control study nested within this study
Inclusion of patients on ICD-10 (with coding quality assessment on 98 hospital records, 97 with positive RT-PCR).
Inclusion of patients only in hospital
Hypertension defined by the use of more than one antihypertensive drug (but prescription possible for other reasons). Patients with hypertensive medications for chronic renal failure or heart failure were excluded from the nested case-control study.
Short follow-up


To study whether the use of ACE inhibitors / ARBs was associated with the diagnosis of COVID-19 and poorer prognosis in COVID-19 patients.


  •     Retrospective cohort study of patients diagnosed with COVID-19, using data from Danish national administrative registers. Inclusion of patients from 22 February to 4 May, identified using ICD-10 codes. Patients followed from the day of diagnosis until May 4 in the absence of death or severe COVID-19.

        Primary endpoint: death

        Secondary endpoint: composite endpoint death or severe VID19

  •     To examine the association between the use of ACE inhibitors / ARBs versus other antihypertensive agents and the incidence rate of COVID-19, a case-control study nested within a cohort study of hypertensive patients was conducted from February 1 to May 4. 1 case for 10 controls (age and gender matched).

        Endpoint: Diagnosis of COVID-19

bibliovid.org and its content are bibliovid property.

Legal Notice