Antihypertensive medications acting on the renin-angiotensin-aldosterone system were not found to increase the risk of either testing positive for coronavirus disease 2019 (COVID-19) or experiencing a more severe disease course, according to the findings of an observational analysis published in the New England Journal of Medicine.

Since the viral receptor for COVID-19 is angiotensin-converting enzyme 2 (ACE2), researchers have questioned whether patients receiving antihypertensive drugs acting on the renin-angiotensin-aldosterone hormonal system have worse outcomes if exposed to the virus. The study, which began in mid-March, aimed to determine the association between previous use of ACE inhibitors, angiotensin-receptor blockers, beta-blockers, calcium-channel blockers, or thiazide diuretics with the likelihood of a positive COVID-19 test result as well as the risk of experiencing severe illness (intensive care, mechanical ventilation, or death). 

The study utilized the New York University (NYU) Langone Health electronic health record to obtain the medical histories of patients who had been tested for COVID-19. “Using Bayesian methods, we compared outcomes in patients who had been treated with these medications and in untreated patients, overall and in those with hypertension, after propensity-score matching for receipt of each medication class,” the authors explained. A difference of ≥10 percentage points was considered to be a substantial difference in the likelihood of the outcome. 

Of the total patients who were tested for COVID-19 (N=12,594), 46.8% (n=5894) tested positive and 17.0% (n=1002) of the positive cases were considered to be severe. Among all the patients, 34.6% (n=4357) had a history of hypertension, and of these patients, 59.1% (n=2573) tested positive for COVID-19 and 24.6% (n=634) experienced severe illness. 

“There was no association between any single medication class and an increased likelihood of a positive test,” the study authors reported. They added, “None of the medications examined was associated with a substantial increase in the risk of severe illness among patients who tested positive.”

The study was conducted to add to the body of evidence related to the optimal care of cardiovascular disease patients diagnosed with COVID-19. In a joint statement, the American Heart Association (AHA), the Heart Failure Society of America (HFSA), and the American College of Cardiology (ACC) highlighted the need for obtaining this additional research. 

Related Articles

“With nearly half of American adults having high blood pressure, and heart disease patients more vulnerable to COVID-19, understanding the relationship between these commonly used medications and COVID-19 was a critical public health concern,” said lead investigator Harmony Reynolds, MD, associate director of the Cardiovascular Clinical Research Center at NYU Langone Health. “Our findings should reassure the medical community and patients about the continued use of these commonly prescribed medications, which prevent potentially severe heart events in their own right.”


Reynolds HR, Adhikari S, Pulgarin C, et al. Renin–angiotensin–aldosterone system inhibitors and risk of Covid-19 [published online May 1, 2020]. New England Journal of Medicine. doi: 10.1056/NEJMoa2008975.