Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor 
blockers (ARBs) share a target receptor with severe acute respiratory syndrome 
coronavirus 2 (SARS-CoV-2). The use of ACEIs/ARBs may cause 
angiotensin-converting enzyme 2 receptor upregulation, facilitating the entry of 
SARS-CoV-2 into host cells. There is concern that the use of ACEIs/ARBs could 
increase the risks of severe COVID-19 and mortality. The impact of discontinuing 
these drugs in patients with COVID-19 remains uncertain. We aimed to assess the 
association between the use of ACEIs/ARBs and the risks of mortality and severe 
disease in patients with COVID-19. A systematic search was performed in PubMed, 
EMBASE, Cochrane Library, and MedRxiv.org from December 1, 2019, to June 20, 
2020. We also identified additional citations by manually searching the 
reference lists of eligible articles. Forty-two observational studies including 
63,893 participants were included. We found that the use of ACEIs/ARBs was not 
significantly associated with a reduction in the relative risk of all-cause 
mortality [odds ratio (OR) = 0.87, 95% confidence interval (95% CI) = 0.75-1.00; 
I 2 = 57%, p = 0.05]. We found no significant reduction in the risk of severe 
disease in the ACEI subgroup (OR = 0.95, 95% CI = 0.88-1.02, I 2 = 50%, p = 
0.18), the ARB subgroup (OR = 1.03, 95% CI = 0.94-1.13, I 2 = 62%, p = 0.48), or 
the ACEI/ARB subgroup (OR = 0.83, 95% CI = 0.65-1.08, I 2 = 67%, p = 0.16). 
Moreover, seven studies showed no significant difference in the duration of 
hospitalization between the two groups (mean difference = 0.33, 95% CI = -1.75 
to 2.40, p = 0.76). In conclusion, the use of ACEIs/ARBs appears to not have a 
significant effect on mortality, disease severity, or duration of 
hospitalization in COVID-19 patients. On the basis of the findings of this 
meta-analysis, there is no support for the cessation of treatment with ACEIs or 
ARBs in patients with COVID-19.