Zhang (2020)
ACEI/ARB use and risk of infection or severity or mortality of COVID-19: A systematic review and meta-analysis
Concomitant medication (Treated with ACEi vs. Not received)
COVID-19 (infection)
Odds ratio: 0.980 (0.920-1.040) Univariate analysis

China, Italy, USA, Asia, Europe, and North America

A systematic review and meta-analysis



The twelve articles of seven cohort studies and five case-control studies. Together, the included articles evaluated more than 19,000 COVID-19 patients. The search strategy included clinical date published until May 9, 2020.

The overall average age of the subjects was greater than 60 years. Clinical outcomes were defined as COVID-19 infection in three studies, severity in severn studies, and mortality in eight studies. To provide a quantitative estimate of the association between ACEI/ARB use and severity or mortality risk in COVID-19 patients, the odds ratios (ORs) (most adjusted, if available) and the corresponding 95 % CIs were extracted from published articles. When the ORs were not given, tabular data were used to calculate the corresponding OR.


COVID-19 (infection)


COVID-19 infection


Concomitant medication

When the studies were grouped by drug type, the risk of COVID-19 infection was not significantly increased among individuals exposed to ACEI

Not received

Treated with ACEi

Odds ratio

0.980 (0.920-1.040)




Meta-analysis for ACEI/ARB use and risk of COVID-19 infection, COVID-19 Mortality, COVID-19 Severity. Pooled OR

To estimate overall risk, random-effects models were adopted. The results of the meta-analysis suggest that use of ACEI/ARB in patients with COVID-19 does not increase the risk of COVID-19 infection, severity, or mortality. However, a lower risk of mortality was observed among those patients who were taking ACEI/ARB for the treatment of hypertension. The findings suggest that ACEI/ARB treatment should be continued in COVID-19 patients who are taking these medications for antihypertensive treatment.