Medical Technology

Fewer Deaths in Hospitalized COVID Patients on an ACEi or ARB

Key Takeaway

  • Patients who had been taking an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) for preexisting hypertension had lower in-hospital mortality but stayed longer in ICU and on a general ward, compared with similar patients not on these drugs, an observational study suggests.

  • The findings are published as a preprint and are not yet peer reviewed.

Why This Matters

  • Throughout the COVID-19 pandemic, experts have debated the effect of renin-angiotensin-aldosterone system therapies such as ACEis and ARBs on susceptibility to, and severity of, infection because the virus binds to the ACE-2 receptor to enter cells.

Study Design

  • Researchers used data from an international observational cohort study involving 354 hospitals in 54 countries. The analysis included 746 adult patients with preexisting hypertension admitted to a hospital intensive care unit with COVID. Of these, 73% reported use of ACEi or ARB therapy within 2 weeks of admission.

Key Results

  • Death during hospitalization occurred in 48% in the ACEi/ARB group and 55% in the group not taking this class of drug (hazard ratio [HR] 0.73; 95% CI, 0.58 – 0.93). The main cause of death was similar in the two groups, although death from septic shock was less frequent in the ACEi/ARB group. 

  • However, length of stay in ICU was actually longer for the ACEi/ARB group: the average time in the ICU was 21.4 days and in a general ward it was 6.7 days, vs 16.2 days and 6.3 days for those not on these treatments. 


  • Limitations included: Lack of information on dose and specific ACEi/ARB agents used, the timing of medications before hospital admission, and if they were continued post-admission.

Study Disclosures

  • The study received discretionary funding from University of Queensland, Wesley Medical Research, The Prince Charles Hospital Foundation, The Health Research Board of Ireland, Biomedicine international training research programme for excellent clinician-scientists, European Union’s research and innovation programme (Horizon 2020), and la Caixa Foundation.

  • Authors Gianluigi Li Bassi and John F Fraser received research funds, through their affiliated institution, from Fisher & Paykel for studies related to high-flow oxygen therapy.

This is a summary of a preprint research study written by Kei Sato from The Prince Charles Hospital on MedRxiv provided to you by Medscape. This study has not yet been peer-reviewed. The full text of the study can be found on

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