Renin-Angiotensin System Inhibitors and Susceptibility to COVID-19 in Patients With Hypertension: A Propensity Score-Matched Cohort Study in Primary Care

Research output: Other contribution


  • S Haroon
  • J Cooper
  • A Anand
  • N Byne
  • S Dhalla
  • D Acosta-Mena
  • K Okoth
  • J Wang
  • C Sainsbury

Colleges, School and Institutes


Introduction: Renin-angiotensin system (RAS) inhibitors have been postulated to influence susceptibility to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). This study investigated whether there is an association
between their prescription and the incidence of COVID-19 and all-cause mortality.

Methods: We conducted a propensity-score matched cohort study comparing the incidence of COVID-19 among patients with hypertension prescribed angiotensin-converting enzyme I (ACE) inhibitors or angiotensin II type-1
receptor blockers (ARBs) to those treated with calcium channel blockers (CCBs) in a large UK-based primary care database (The Health Improvement Network). We estimated crude incidence rates for confirmed/suspected COVID-19 in each drug exposure group. We used Cox proportional hazards models to produce adjusted hazard ratios for COVID-19. We assessed all-cause mortality as a secondary outcome.

Results: The incidence rate of COVID-19 among users of ACE inhibitors and CCBs was 9.3 per 1000 person-years (83 of 18,895 users [0.44%]) and 9.5 per 1000 person-years (85 of 18,895 [0.45%]), respectively. The adjusted hazard ratio was 0.92 (95% CI 0.68 to 1.26). The incidence rate among users of ARBs was 15.8 per 1000 person-years (79 out of 10,623 users [0.74%]). The adjusted hazard ratio was 1.38 (95% CI 0.98 to 1.95). There were no significant associations between use of RAS inhibitors and all-cause mortality.


Original languageEnglish
PublisherBMC Infectious Diseases
Publication statusPublished - Dec 2020