Association Between Baseline Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers and Death Among Patients Tested for COVID-19

Sarah A. Thomas, Michael Puskarich, Michael S. Pulia, Andrew C. Meltzer, Carlos A. Camargo, D. Mark Courtney, Kristen E. Nordenholz, Jeffrey A. Kline, Christopher Kabrhel

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) drugs may modify risk associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Therefore, we assessed whether baseline therapy with ACEIs or ARBs was associated with lower mortality, respiratory failure (noninvasive ventilation or intubation), and renal failure (new renal replacement therapy) in SARS-CoV-2-positive patients. This retrospective registry-based observational cohort study used data from a national database of emergency department patients tested for SARS-CoV-2. Symptomatic emergency department patients were accrued from January to October 2020, across 197 hospitals in the United States. Multivariable analysis using logistic regression evaluated end points among SARS-CoV-2–positive cases, focusing on ACEIs/ARBs and adjusting for covariates. Model performance was evaluated using the c statistic for discrimination and Cox plotting for calibration. A total of 13 859 (99.9%) patients had known mortality status, of whom 2045 (14.8%) died. Respiratory failure occurred in 2485/13 880 (17.9%) and renal failure in 548/13 813 (4.0%) patients with available data. ACEI/ARB status was associated with a 25% decrease in mortality odds (odds ratio [OR], 0.75; 95%CI, 0.59-0.94; P =.011; c =.82). ACEIs/ARBs were not significantly associated with respiratory failure (OR, 0.89; 95%CI, 0.78-1.06; P =.206) or renal failure (OR, 0.75; 95%CI, 0.55-1.04; P =.083). Adjusting for covariates, baseline ACEI/ARB was associated with 25% lower mortality in SARS-CoV-2–positive patients. The potential mechanism for ACEI/ARB mortality modification requires further exploration.

Original languageEnglish (US)
Pages (from-to)777-782
Number of pages6
JournalJournal of Clinical Pharmacology
Issue number6
StatePublished - Jun 2022
Externally publishedYes

Bibliographical note

Funding Information:
Dr Puskarich's institution received grant funding for clinical trials of losartan for COVID‐19 (Bill and Melinda Gates Foundation, Minnesota Partnership for Biotechnology and Medical Genomics).

Publisher Copyright:
© 2021, The American College of Clinical Pharmacology.

PubMed: MeSH publication types

  • Journal Article
  • Observational Study
  • Research Support, Non-U.S. Gov't


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