RAS inhibitors not linked to increased risk of death from COVID-19

Concerns have been raised that the use of a common group of medications called RAS inhibitors could facilitate SARS-CoV-2 infection, impact COVID-19 disease severity and worsen prognosis. However, in a new nationwide registry-based study from Karolinska Institutet in Sweden, including almost 1.4 million patients, use of RAS inhibitors was not associated with increased risk of hospitalisation or death from COVID-19. The study has been published in the European Journal of Heart Failure.

The new coronavirus SARS-CoV-2 enters human cells by binding its outer spike protein to the angiotensin-converting enzyme 2 (ACE2) receptor on the target cells. Because renin-angiotensin-aldosterone-system (RAS) inhibitors increase ACE2 levels, concerns regarding the use of these treatments during the COVID-19 pandemic have been raised.

The generic names of RAS inhibitors end in ‘pril’ or ‘sartan’ (some examples are enalapril, kaptopril, losartan,valsartanand kandesartan). They are commonly used for the treatment of hypertension, heart failure, diabetes, kidney disease and ischemic heart disease. In this study, all patients with these conditions registered in the Swedish National Patient Registry on February 1, 2020, were included and followed until May 31.

Of 1,387,746 patients, the majority received RAS inhibitors. In total, 0.51 percent of the patients were hospitalised or died from COVID-19. After adjustment for 45 variables, RAS inhibitor use was associated with a slightly reduced risk of hospitalisation or death from COVID-19.

“Our results show that RAS inhibitors are unlikely to have any negative effects on the outcome for COVID-19 patients,” says lead author Gianluigi Savarese, associate professor of cardiology at the Department of Medicine, Solna, Karolinska Institutet and consultant in heart failure at Karolinska University Hospital in Sweden.

This study received support from the EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking BigData@Heart grant, the Swedish Research Council and the Swedish Heart-Lung Foundation. Three of the authors have received grants and/or fees from pharmaceutical companies, all outside of the submitted work. See the scientific paper for a complete list of potential conflicts of interest.

Full bibliographic information


“Association between Renin‐Angiotensin‐Aldosterone system inhibitor use and COVID‐19 hospitalization and death: A 1,4 million patient Nation‐Wide registry analysis”. Gianluigi Savarese, Lina Benson, Johan Sundström, Lars H Lund. European Journal of Heart Failure, online 22 November 2020, doi: 10.1002/ejhf.2060.

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