COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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. 2020 Nov 2. pii: S0914-5087(20)30353-1. doi: 10.1016/j.jjcc.2020.10.015.

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.