RAAS Inhibitors Not Found to Be Associated With Greater Odds of Testing Positive for COVID-19

Use of angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) was not found to be associated with greater odds of testing positive for coronavirus disease 2019 (COVID-19), according to a meta-analysis published in the American Journal of Cardiology.

As the effect of renin-angiotensin-aldosterone (RAAS) inhibitors on susceptibility to and prognosis of COVID-19 remains unclear, researchers conducted a meta-analysis of all available data to determine the role of the system in this emerging disease.

PubMed and Scopus were examined in May 2020 and studies were included if they met the following criteria: 1- reporting of the risk for testing positive for COVID-19 and/or for mortality in patients positive for COVID-19, and 2- included a comparison of patients with hypertension  prescribed vs not prescribed RAAS inhibitors. Odds ratios (ORs) from each study were pooled using a random-effects model.

In total, 9 studies with a total of 80,526 patients (n=21,642 taking ACEI/ARB and n=58,884 not taking either of these drugs) were included in the analysis. No association was established in the pooled analysis between the likelihood of testing positive for COVID-19 and the use of ACEIs (OR, 0.96; 95% CI, 0.88-1.04; P =0.29) or ARBs (OR, 0.99; 95% CI, 0.91-1.08; P  =.90). The mortality rate was comparable in patients with hypertension treated vs not treated with a RAAS inhibitor (OR, 0.57; 95% CI, 0.20-1.33; P =.25).

Limitations of the study include the inability to analyze data of patients treated with ACEI and ARB separately, and the fact that comorbidities may have confounded the results.

“Our results support the consensus by multiple specialty societies, which recommended continued usage of RAAS inhibitors in [patients with] COVID-19 and among the general public who have been prescribed these medications,” concluded the study authors.


Usman MS, Siddiqi TJ, Khan MS, Ahmed A, Ali SS, Michos ED, et al. A meta-analysis of the relationship between renin-angiotensin-aldosterone system inhibitors and COVID-19 (published online June 2, 2020). Am J Cardiol. doi:10.1016/j.amjcard.2020.05.038