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  3. Vol. 14 No. 1 (2026): Winter 2026
  4. Original Article

Vol. 14 No. 1 (2026)

February 2026

Effect of ACE Inhibitors, ARBs, and Other Antihypertensive Drugs on Hypertensive Patients with COVID-19 Infection

  • Seyedpouzhia Shojaei
  • Sara Nooraeen
  • Zahra Soroureddin
  • Meghdad Sedaghat
  • Padideh Ansar
  • Sadaf Rassouli
  • Mehdi Goudarzi
  • Mehrdad Haghighi

Novelty in Biomedicine, Vol. 14 No. 1 (2026), 8 February 2026 , Page 21-28
https://doi.org/10.22037/nbm.v14i1.50109 Published: 2026-02-08

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Abstract

Background: To investigate differences in disease severity and outcomes among COVID-19 patients with a history of hypertension using angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and other antihypertensive drugs.

Materials and Methods: Based on drug exposure, 153 hypertensive patients with COVID-19 were divided into three groups: angiotensin-converting enzyme inhibitor group, angiotensin receptor blocker group, and other antihypertensive drugs group. The outcomes, laboratory and clinical results, were compared.

Results: The frequency of ICU admission among patients in the angiotensin receptor blocker, angiotensin-converting enzyme inhibitor, and other antihypertensive drug groups was 25.5%, 27.8%, and 23.2%, respectively. The intubation frequency was 23.6%, 27.8%, and 30.4%, respectively. The longest hospital stay was observed in the angiotensin-converting enzyme inhibitor group, but the difference was not significant (P>0.05). The mortality rates were highest in the other antihypertensive drug groups.

Conclusion: Patients with COVID-19 who consume angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have lower mortality rates compared to patients consuming other antihypertensive drugs.

Keywords:
  • COVID-19
  • SARS-CoV-2
  • Angiotensin-converting enzyme 2
  • Angiotensin receptor blockers
  • Angiotensin-converting enzyme inhibitors
  • Antihypertensive drugs
  • Outcomes
  • pdf

How to Cite

Shojaei, S., Nooraeen, S., Soroureddin, Z., Sedaghat, M., Ansar, P., Rassouli, S., … Haghighi, M. (2026). Effect of ACE Inhibitors, ARBs, and Other Antihypertensive Drugs on Hypertensive Patients with COVID-19 Infection. Novelty in Biomedicine, 14(1), 21–28. https://doi.org/10.22037/nbm.v14i1.50109
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References

1. Zaki AM, van Boheemen S, Bestebroer TM, Osterhaus ADME, Fouchier RAM. Isolation of a novel coronavirus from a man with pneumonia in Saudi Arabia. N Engl J Med. 2012;367(19):1814-20.

2. Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-3.

3. Rota PA, Oberste MS, Monroe SS, Nix WA, Campagnoli R, Icenogle JP, et al. Characterization of a novel coronavirus associated with severe acute respiratory syndrome. Science. 2003;300(5624):1394-9.

4. Li W, Moore MJ, Vasilieva N, Sui J, Wong SK, Berne MA, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature. 2003;426(6965):450-4.

5. Tipnis SR, Hooper NM, Hyde R, Karran E, Christie G, Turner AJ. A human homolog of angiotensin-converting enzyme. Cloning and functional expression as a captopril-insensitive carboxypeptidase. J Biol Chem. 2000;275(43):33238-43.

6. Donoghue M, Hsieh F, Baronas E, Godbout K, Gosselin M, Stagliano N, et al. A novel angiotensin-converting enzyme-related carboxypeptidase (ACE2) converts angiotensin I to angiotensin 1-9. Circ Res. 2000;87(5):E1-9.

7. Keidar S, Kaplan M, Gamliel-Lazarovich A. ACE2 of the heart: from angiotensin I to angiotensin (1-7). Cardiovasc Res. 2007;73(3):463-9.

8. Santos RAS, Sampaio WO, Alzamora AC, Motta-Santos D. The ACE2/angiotensin-(1-7)/Mas axis of the renin-angiotensin system: focus on angiotensin-(1-7). Physiol Rev. 2018;98(1):505-53.

9. Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631-7.

10. Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-3.

11. Skeggs LT Jr, Kahn JR, Shumway NP. The preparation and function of the hypertensin-converting enzyme. J Exp Med. 1956;103(3):295-9.

12. Nicklin S. A novel mechanism of action for angiotensin-(1-7) via the angiotensin type 1 receptor. Hypertension. 2016;68:1342-3.

13. Tikellis C, Thomas MC. Angiotensin-converting enzyme 2 (ACE2) is a key modulator of the renin angiotensin system in health and disease. Int J Pept. 2012;2012:256294.

14. Keidar S, Kaplan M, Gamliel-Lazarovich A. ACE2 of the heart: from angiotensin I to angiotensin (1-7). Cardiovasc Res. 2007;73(3):463-9.

15. Qiao W, Wang C, Chen B, Zhang F, Liu Y, Lu Q, et al. Ibuprofen attenuates cardiac fibrosis in streptozotocin-induced diabetic rats. Cardiology. 2015;131(2):97-106.

16. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020;8(4):e21.

17. Gilstrap LG, Fonarow GC, Desai AS, Liang L, Matsouaka R, DeVore AD, et al. Initiation, continuation, or withdrawal of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and outcomes in patients hospitalized with heart failure with reduced ejection fraction. J Am Heart Assoc. 2017;6(2):e004675.

18. Pflugfelder PW, Baird MG, Tonkon MJ, DiBianco R, Pitt B. Clinical consequences of angiotensin-converting enzyme inhibitor withdrawal in chronic heart failure: a double-blind, placebo-controlled study of quinapril. J Am Coll Cardiol. 1993;22(6):1557-63.

19. Lee SM, Takemoto S, Wallace AW. Association between withholding angiotensin receptor blockers in the early postoperative period and 30-day mortality. Anesthesiology. 2015;123(2):288-306.

20. Mudumbai SC, Takemoto S, Cason BA, Au S, Upadhyay A, Wallace AW. Thirty-day mortality risk associated with the postoperative nonresumption of angiotensin-converting enzyme inhibitors. J Hosp Med. 2014;9(5):289-96.

21. World Health Organization. Laboratory testing for coronavirus disease (COVID-19) in suspected human cases: interim guidance. Geneva: WHO; 2020 March 19.

22. Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020.

23. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020.

24. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20.

25. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China. Lancet. 2020;395(10229):1054-62.

26. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China. Lancet. 2020;395(10223):507-13.

27. Chiusano M. The modelling of COVID-19 pathways sheds light on mechanisms, opportunities and controversial interpretations of medical treatments. 2020.

28. Peng YD, Meng K, Guan HQ, Leng L, Zhu RR, Wang BY, et al. Clinical characteristics and outcomes of 112 cardiovascular disease patients infected by 2019-nCoV. Zhonghua Xin Xue Guan Bing Za Zhi. 2020;48:E004.

29. Yang G, Tan Z, Zhou L, Yang M, Peng L, Liu J, et al. Angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors usage is associated with improved inflammatory status and clinical outcomes in COVID-19 patients with hypertension. medRxiv. 2020.

30. Ocaranza MP, Godoy I, Jalil JE, Varas M, Collantes P, Pinto M, et al. Enalapril attenuates downregulation of angiotensin-converting enzyme 2 in the late phase of ventricular dysfunction in myocardial infarcted rat. Hypertension. 2006;48(4):572-8.

31. Zhong J, Ye JY, Jin HY, Yu X, Yu HM, Zhu DL, et al. Telmisartan attenuates aortic hypertrophy in hypertensive rats by modulation of ACE2 and profilin-1 expression. Regul Pept. 2011;166:90-7.

32. Ferrario CM. Myocardial infarction increases ACE2 expression in rat and humans. Eur Heart J. 2005;26(11):1141.

33. Liu Y, Huang F, Xu J, Yang P, Qin Y, Cao M, et al. Antihypertensive angiotensin II receptor blockers associated with mitigation of disease severity in elderly COVID-19 patients. medRxiv. 2020.

34. Meng J, Xiao G, Zhang J, He X, Ou M, Bi J, et al. Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension. Emerg Microbes Infect. 2020;9(1):757-60.

35. Fan J, Liu X, Pan W, Douglas MW, Bao S. Epidemiology of 2019 novel coronavirus disease-19 in Gansu Province, China. Emerg Infect Dis. 2020;26(6).

36. Lu J, Wang X, Li X, Linderman G, Wu C, Cheng X, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1.7 million adults in a population-based screening study. Lancet. 2017;390.

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