Association of renin-angiotensin system inhibitors with risk of death in 
patients with hypertension (HTN) and coronavirus disease 2019 (COVID-19) is not 
well characterized. The aim of this study was to evaluate the outcomes of 
patients with HTN and COVID-19 with respect to different chronic 
antihypertensive drug intake. We performed a retrospective, observational study 
from a large cohort of patients with HTN and with a laboratory-confirmed severe 
acute respiratory syndrome coronavirus 2 infection admitted to the Emergency 
Rooms (ER) of the Piacenza Hospital network from February 21, 2020 to March 20, 
2020. There were 1050 patients admitted to the ERs of the Piacenza Hospital 
network with COVID-19. HTN was present in 590 patients [median age, 76.2 years 
(IQR 68.2-82.6)]; 399 (66.1%) patients were male. Of them, 248 patients were 
chronically treated with ACEi, 181 with ARBs, and 161 with other drugs (O-drugs) 
including beta blockers, diuretics and calcium-channel inhibitors. With respect 
to the antihypertensive use, there was no difference between comorbid 
conditions. During a follow-up of 38 days (IQR 7.0-46.0), 256 patients (43.4%) 
died, without any difference stratifying for antihypertensive drugs. Of them, 
107 (43.1%) were in ACEi group vs 67 (37%) in ARBs group vs 82 (50.7%) in 
O-drugs group, (log-rank test: p = 0.066). In patients with HTN and COVID-19, 
neither ACEi nor ARBs were independently associated with mortality. After 
adjusting for potential confounders in risk prediction, the rate of death was 
similar. Our data confirm Specialty Societal recommendations, suggesting that 
treatment with ACEIs or ARBs should not be discontinued because of COVID-19.