COVID-19 Evidence Alerts
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Etiology Ren L, Yu S, Xu W, et al. Lack of association of antihypertensive drugs with the risk and severity of COVID-19: A meta-analysis. J Cardiol. 2021 May;77(5):482-491. doi: 10.1016/j.jjcc.2020.10.015. Epub 2020 Nov 2.

BACKGROUND: The association of antihypertensive drugs with the risk and severity of COVID-19 remains unknown.

METHODS AND RESULTS: We systematically searched PubMed, MEDLINE, The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL),, and medRxiv for publications before July 13, 2020. Cohort studies and case-control studies that contain information on the association of antihypertensive agents including angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), calcium-channel blockers (CCBs), ß-blockers, and diuretics with the risk and severity of COVID-19 were selected. The random or fixed-effects models were used to pool the odds ratio (OR) with 95% confidence interval (CI) for the outcomes. The literature search yielded 53 studies that satisfied our inclusion criteria, which comprised 39 cohort studies and 14 case-control studies. These studies included a total of 2,100,587 participants. We observed no association between prior usage of antihypertensive medications including ACEIs/ARBs, CCBs, ß-blockers, or diuretics and the risk and severity of COVID-19. Additionally, when only hypertensive patients were included, the severity and mortality were lower with prior usage of ACEIs/ARBs (overall OR of 0.81, 95% CI 0.66-0.99, p < 0.05 and overall OR of 0.77, 95% CI 0.66-0.91, p < 0.01).

CONCLUSIONS: Taken together, usage of antihypertensive drugs is not associated with the risk and severity of COVID-19. Based on the current available literature, it is not recommended to abstain from the usage of these drugs in COVID-19 patients.

REGISTRATION: The meta-analysis was registered on OSF (

Discipline / Specialty Area Score
Internal Medicine
Comments from MORE raters

Internal Medicine rater

As an internist who is treating patients with hypertension, I find this article is of great interest. It is very helpful because of the fear that the use of renin-angiotensin system (RAS) blockers could potentially increase the risk for and the severity of COVID-19. It assures medical practitioners that the use of anti-hypertensives including RAS-blockers is safe even during the pandemic. The results of this meta-analysis should be disseminated especially the result that prior use of ACE-inhibitors and ARB's rather than increasing risk, are actually associated with lower risk of severe COVID-19 and lower mortality.