Bean (2020)
Treatment with ACE-inhibitors is associated with less severe disease with SARS-Covid-19 infection in a multi-site UK acute Hospital Trust
Concomitant medication (Treated with ACEi vs. Not received)
COVID-19 (severe/fatal)
Odds ratio: 0.340 (0.110-0.860) Adjusted model

United Kingdom

Retrospective observational study

Medical records


An early cohort of 205 acute inpatients with COVID-19 at King’s College Hospital and Princess Royal University Hospital, London, UK

205 confirmed positive symptomatic inpatients aged 63+20 (SD) years and 52% males. Baseline characteristics are 51·2% with hypertension, 30·2% with diabetes and 14·6% with ischaemic heart disease or heart failure. Of the 205 patients, 53 patients died or required critical care support within 7 days of symptoms and 152 patients did not. The inclusion criteria of only patients needing admission is likely why this critical outcome figure is relatively high (25·9%) compared to fatality rate in population studies but is comparable to hospital case series.17 14% (5/37) patients with exposure to an ACE-inhibitor died or required critical care support compared to 29% (48/168) for patients without such exposure.


7 Day

COVID-19 (severe/fatal)


Death or admission to a critical care unit for organ-support within 7 days of symptoms onset (symptoms defined as fever, cough, dyspnoea, myalgia, chest pain or delirium). Patients were stratified according to drug exposure to ACEi or ARB within 7 days before symptoms or during inpatient treatment (prior to an endpoint being reached).


Concomitant medication

ACEi admisitration for hypertension (Ramipril, Perindopril, Lisinopril, Enalapril, Captopril, Quinapril,Imidapril, Fosinopril, Trandolapril)

Not received

Treated with ACEi

Odds ratio

0.340 (0.110-0.860)




ACEi treatment, age, gender (model 1)

Based on these early results and the absence of any evidence suggesting harm,patients on treatment with ACE-inhibitors should continue these drugs during their COVID-19 illness as per current guidelines. Active research is merited on whether ACE inhibition or enhancement of ACE2 may have a therapeutic role in severe COVID-19 disease.