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Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Testing
Neil Mehta1, Ankur Kalra2,3, Amy S Nowacki4
1Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio.
Insights
This study found no association between angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) use and COVID-19 positivity. Clinical data support continuing these essential medications during the pandemic.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- The role of ACE inhibitors (ACEI) and ARBs in COVID-19 is debated.
- Recommendations to discontinue these essential chronic disease medications exist.
- Professional societies advocate continued use due to lack of clinical evidence.
Purpose of the Study:
- To investigate the association between ACEI/ARB use and COVID-19 test positivity.
- To examine COVID-19 outcomes in patients using ACEI/ARBs.
Main Methods:
- Retrospective cohort study at Cleveland Clinic Health System.
- Included patients tested for COVID-19 between March 8 and April 12, 2020.
- Used overlap propensity score weighting for analysis.
Main Results:
- 18,472 patients tested; 12.4% were on ACEI/ARBs.
- No significant association between ACEI/ARB use and COVID-19 positivity (OR, 0.97; 95% CI, 0.81-1.15).
- Further study needed on hospitalized patients for severity association.
Conclusions:
- ACEI/ARB use is not associated with COVID-19 test positivity.
- Supports guidelines for continuing ACEI/ARB therapy during the COVID-19 pandemic.
- Further research is required for severe COVID-19 outcomes.
Importance:
The role of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) in the setting of the coronavirus disease 2019 (COVID-19) pandemic is hotly debated. There have been recommendations to discontinue these medications, which are essential in the treatment of several chronic disease conditions, while, in the absence of clinical evidence, professional societies have advocated their continued use.
Objective:
To study the association between use of ACEIs/ARBs with the likelihood of testing positive for COVID-19 and to study outcome data in subsets of patients taking ACEIs/ARBs who tested positive with severity of clinical outcomes of COVID-19 (eg, hospitalization, intensive care unit admission, and requirement for mechanical ventilation).
Design, Setting, And Participants:
Retrospective cohort study with overlap propensity score weighting was conducted at the Cleveland Clinic Health System in Ohio and Florida. All patients tested for COVID-19 between March 8 and April 12, 2020, were included.
Exposures:
History of taking ACEIs or ARBs at the time of COVID-19 testing.
Main Outcomes And Measures:
Results of COVID-19 testing in the entire cohort, number of patients requiring hospitalizations, intensive care unit admissions, and mechanical ventilation among those who tested positive.
Results:
A total of 18 472 patients tested for COVID-19. The mean (SD) age was 49 (21) years, 7384 (40%) were male, and 12 725 (69%) were white. Of 18 472 patients who underwent COVID-19 testing, 2285 (12.4%) were taking either ACEIs or ARBs. A positive COVID-19 test result was observed in 1735 of 18 472 patients (9.4%). Among patients who tested positive, 421 (24.3%) were admitted to the hospital, 161 (9.3%) were admitted to an intensive care unit, and 111 (6.4%) required mechanical ventilation. Overlap propensity score weighting showed no significant association of ACEI and/or ARB use with COVID-19 test positivity (overlap propensity score-weighted odds ratio, 0.97; 95% CI, 0.81-1.15).
Conclusions And Relevance:
This study found no association between ACEI or ARB use and COVID-19 test positivity. These clinical data support current professional society guidelines to not discontinue ACEIs or ARBs in the setting of the COVID-19 pandemic. However, further study in larger numbers of hospitalized patients receiving ACEI and ARB therapy is needed to determine the association with clinical measures of COVID-19 severity.
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