Use of Renin-Angiotensin System Antagonists in Patients with Hypertension and COVID-19 Infection: A Rapid Review and Meta-analysis
Among patients with confirmed COVID-19 infection and hypertension, there is insufficient evidence that RAS
antagonists are associated with mortality or severe COVID-19 disease.
• There is uncertainty with regards to the safe use of renin-angiotensin system (RAS) antagonists, such as
angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB), for COVID-19 patients
with hypertension and other comorbidities (heart failure, chronic kidney disease) because of two possible
contradictory mechanisms 1) upregulation of ACE2 receptors that may facilitate the virus entry into the lung.
and 2) control of unabated angiotensin II levels reducing acute lung injury.
• Based on very low-quality retrospective cohort studies, there is insufficient evidence that RAS antagonists are
associated with increased mortality (6 studies) or severe disease (10 studies) among patients with confirmed
COVID-19 infection and hypertension.
• There are 36 ongoing studies (21 RCTs, 1 single-arm trial, 4 prospective cohorts, 4 retrospective cohorts, 4 casecontrol, and 2 cross-sectional) on this topic.
• The European Society of Cardiology (ESC) Council on Hypertension, the International Society of Hypertension
(ISH) and the joint statement by the American College of Cardiology (ACC), American Heart Association (AHA),
and Heart Failure Society of America (HFSA) all caution against discontinuing RAS-related treatments in
patients with hypertension who become infected with COVID-19.