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
Patient characteristics
Age (10 year increase vs. Not applicable)
COVID-19 (severe/fatal)
Odds ratio: 1.000 (0.850-1.300) 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).

Patient characteristics


adjusted the model for age. inpatients aged 63+20

Not applicable

10 year increase

Odds ratio

1.000 (0.850-1.300)




ACEi, Age and gender, diabetes, hypertension, ischaemic heart disease or heart failure (Model 3)

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.