ACEI/ARB Use and Testing Positive for COVID-19

Quick Takes

  • This retrospective cohort study reports no association between ACEI or ARB use and COVID-19 test positivity.
  • Overall, these data support various society guidelines to continue current treatment of chronic disease conditions with either ACEIs or ARBs during the COVID-19 pandemic.
  • The data for clinical outcomes and measures of COVID-19 severity taking ACEIs and ARBs must be interpreted with caution, given multiple limitations.

Study Questions:

What is the association between use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) with the likelihood of testing positive for coronavirus disease 2019 (COVID-19), and outcomes in subsets of patients taking ACEIs/ARBs who tested positive with severity of clinical outcomes of COVID-19?


The investigators conducted a retrospective cohort study with overlap propensity score weighting at the Cleveland Clinic Health System in Ohio and Florida. All patients tested for COVID-19 between March 8 and April 12, 2020, were included. History of taking ACEIs or ARBs at the time of COVID-19 testing was obtained. The main outcome measures were results of COVID-19 testing in the entire cohort, number of patients requiring hospitalizations, intensive care unit admissions, and mechanical ventilation among those who tested positive. Overlap propensity score–weighted logistic regression models investigated associations between medication status and the probability of testing positive for COVID-19, as well as other clinical outcomes.


A total of 18,472 patients tested for COVID-19. The mean (standard deviation) age was 49 (21) years, 7,384 (40%) were male, and 12,725 (69%) were white. Of 18,472 patients who underwent COVID-19 testing, 2,285 (12.4%) were taking either ACEIs or ARBs. A positive COVID-19 test result was observed in 1,735 of 18,472 patients (9.4%). Among patients who tested positive, 421 (24.3%) were admitted to the hospital, 161 (9.3%) were admitted to an intensive care unit, and 111 (6.4%) required mechanical ventilation. Overlap propensity score weighting showed no significant association of ACEI and/or ARB use with COVID-19 test positivity (overlap propensity score–weighted odds ratio, 0.97; 95% confidence interval, 0.81-1.15).


The authors concluded that their study found no association between ACEI or ARB use and COVID-19 test positivity.


This retrospective cohort study reports that taking either an ACEI or ARB was not associated with an increase in the likelihood of testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. While overlap propensity score–weighted analysis showed a higher likelihood of hospital admission among patients with positive test results who were taking either ACEIs or ARBs, these data must be interpreted with caution and considered only hypothesis generating, due to the small sample size and the wide width of the confidence intervals.

Clinical Topics: COVID-19 Hub, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure

Keywords: Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Coronavirus, Coronavirus Infections, COVID-19, Heart Failure, Intensive Care Units, Patient Admission, Secondary Prevention, Respiration, Artificial, severe acute respiratory syndrome coronavirus 2

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