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March 24, 2020

COVID-19 and Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers: What Is the Evidence?

Author Affiliations
  • 1Renal Division, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA. 2020;323(18):1769-1770. doi:10.1001/jama.2020.4812

Coronavirus disease 2019 (COVID-19) is a current pandemic infection caused by a positive-sense RNA virus named the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The particularly infectious capacity of the virus, along with mortality rates ranging from 1% to above 5%, has raised concerns across the globe.1 Older patients with comorbid conditions including pulmonary disease, cardiac disease, kidney disease, diabetes, and hypertension have been associated with even higher mortality rates, suggesting particularly susceptible populations.

The increased mortality and morbidity of COVID-19 in patients with hypertension is an association that has been observed in a number of initial epidemiological studies outlining the characteristics of the COVID-19 epidemic in China. Wu et al2 found hypertension to have a hazard ratio of 1.70 for death and 1.82 for acute respiratory distress syndrome in 201 patients with COVID-19. Zhou et al3 found hypertension to have a hazard ratio of 3.05 for in-hospital mortality in 191 patients with COVID-19.

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    1 Comment for this article
    ARBs and ACE 1 Inhibitors used in the field
    Paul Winter, M.Sc. Health Studies. | Open University
    May I draw the authors' attention to a paper and its references of profound relevance regarding these drugs (1). The reference refers to the effect of altered host response using the drugs in question to Ebola infection. 3 of 100 patients with EVD treated with atorvastain and irbesartan in Sierra Leone died. The author postulates that statins and ARBs could be transformational in treating the next flu pandemic and emergent coronavirus similar to SARS. I would suggest that we will now have the data if someone has the wherewithal to seek it out, in that if the author is correct, patients routinely receiving these drugs will be largely absent from intensive care units and mortality data. I have little doubt that South Korea if requested could interrogate their datasets and come up with a definitive answer in days if not hours. The link to the article published through the University of Edinburgh in Scotland is here:


    1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571110/?fbclid=IwAR2u1jB_zIZ4hU3h4olHpUjZnhR9okYWFz82moXqoZH2M6dZrvsFRFKZmno