dcyphr | Outcomes in Patients With COVID-19 Infection Taking ACEI/ARB


The purpose of this article is to investigate the effects of ACEI/ARB on COVID-19 patients. Theoretically, ACEI/ARB should help COVID-19 patients similarly to SARS-CoV patients, but many major cardiology scientific associations have denied this. This study concludes that an association between ACEI/ARB and positive effects on COVID-19 patients is not supported. This may change in the future, however. 


SARS-CoV-2 is similar to SARS-CoV and MERS. Studies show the virus binding to angiotensin-converting enzyme 2 (ACE2) receptors, allowing it to replicate and transport through the lungs. Angiotensin-converting enzyme inhibitors (ACEI) are medicines that block ACE2 receptors, protecting against infection. 


ACE2 receptors act to counter-regulate renin-angiotensin-aldosterone system (RAAS) activation. RAAS is a hormone system involved in regulating blood pressure and fluid and electrolyte balance. The RAAS system has a major role in people suffering from diabetes, hypertension, or heart failure. ACEI and ARB (angiotensin II receptor blocker) drugs are often used to help with these conditions (i.e., hypertension and heart failure). 

COVID-19 and Comorbidity

Hypertension and diabetes are major risk factors for infection and poorer outcomes of COVID-19. Studies have not combined ACEI use with COVID-19 patients showcasing hypertension and/or diabetes. ACEI use has not been shown to affect COVID-19 outcomes. SARS-CoV-2, SARS-CoV, and MERS all show a common association with damaging cardiac events. 

Pros and Cons of ACE Inhibition 

ACE2 receptors may be involved with cardiac events associated with SARS-CoV-2. Drugs that increase activity at ACE2 receptors may increase the risk of infection and worse outcomes in COVID-19 patients. ACEI may inadvertently lead to ACE2 upregulation, which would allow SARS-CoV-2 to bind to more sites and increase infection. This has been seen with COVID-19 patients taking ACEI or ARB drugs for hypertension or diabetes. Other investigators have argued that using ACEI actually disrupts ACE2 pathways, then decreasing ACE2 production and decreasing the likelihood of SARS-CoV-2 infection. However, no causal relationship between ACEI use and decreased risk for death has been established. Cardiology associations have urged those using ACEI/ARB medications to continue using them while infected with COVID-19. 


More research is needed regarding the relationship between ACEI use and COVID-19 outcomes. There is not enough evidence to support halting ACEI use as they still help with hypertension and diabetes, so COVID-19 patients already using them should continue to do so.