Renin-Angiotensin-Aldosterone Inhibitors and Susceptibility to and Severity of COVID-19

Bottom Line:

Contrary to initial beliefs, use of ACEIs and ARBs is not associated with increased susceptibility to SARS-CoV-2 infection or increased severity of COVID-19.


Curfman, G. Renin-Angiotensin-Aldosterone Inhibitors and Susceptibility to and Severity of COVID-19. JAMA (2020). DOI:10.1001/jama.2020.11401

Date Published:

19 June 2020


To enter a human cell, SARS-CoV-2 uses its spike protein and two host cell proteins, ACE2 and TMPRSS2. A previous 2017 study demonstrated that use of ACE inhibitors (ACEI) and angiotensin receptor blockers (ARB) upregulated ACE2 in cell membranes, leading many to think (early in the pandemic) about the possibility about discontinuing these medications in patients with and at risk of acquiring COVID-19. The author presents new evidence in this article that suggests these medications are not associated with either increased susceptibility or severity of the illness. A retrospective cohort study in Denmark of 4480 patients found no significant difference in mortality rate between patients receiving the medications compared to those not receiving them, with a 95% confidence interval. The research addresses concerns over use of ACEIs and ARBs in the COVID-19 pandemic and suggests that ACE2 upregulation alone does not change the virus’ ability to infect cells and replicate within the body.

Summary by: Mike Ge