BACKGROUND: The association of ACE inhibitors (ACEIs) and angiotensin II 
receptor blockers (ARBs) with disease severity of patients with COVID-19 is 
still unclear. We conducted a systematic review and meta-analysis to investigate 
if ACEI/ARB use is associated with the risk of mortality and severe disease in 
patients with COVID-19.
METHODS: We searched all available clinical studies that included patients with 
confirmed COVID-19 who could be classified into an ACEI/ARB group and a 
non-ACEI/ARB group up until 4 May 2020. A meta-analysis was performed, and 
primary outcomes were all-cause mortality and severe disease.
RESULTS: ACEI/ARB use did not increase the risk of all-cause mortality both in 
meta-analysis for 11 studies with 12 601 patients reporting ORs (OR=0.52 (95% 
CI=0.37 to 0.72), moderate certainty of evidence) and in 2 studies with 8577 
patients presenting HRs. For 12 848 patients in 13 studies, ACEI/ARB use was not 
related to an increased risk of severe disease in COVID-19 (OR=0.68 (95% CI=0.44 
to 1.07); I2=95%, low certainty of evidence).
CONCLUSIONS: ACEI/ARB therapy was not associated with increased risk of 
all-cause mortality or severe manifestations in patients with COVID-19. ACEI/ARB 
therapy can be continued without concern of drug-related worsening in patients 
with COVID-19.