OBJECTIVE: Although recent evidence suggests no increased risk of severe 
COVID-19 outcomes associated with angiotensin-converting enzyme inhibitors 
(ACEIs) or angiotensin receptor blockers (ARBs) use, the relationship is less 
clear among patients with hypertension and diverse racial/ethnic groups. This 
study evaluates the risk of hospitalization and mortality among patients with 
hypertension and COVID-19 in a large US integrated healthcare system.
METHODS: Patients with hypertension and COVID-19 (between March 1- September 1, 
2020) on ACEIs or ARBs were compared with patients on other frequently used 
antihypertensive medications.
RESULTS: Among 14,129 patients with hypertension and COVID-19 infection (mean 
age 60 years, 48% men, 58% Hispanic), 21% were admitted to the hospital within 
30 days of COVID-19 infection. Of the hospitalized patients, 24% were admitted 
to intensive care units, 17% required mechanical ventilation, and 10% died 
within 30 days of COVID-19 infection. Exposure to ACEIs or ARBs prior to 
COVID-19 infection was not associated with an increased risk of hospitalization 
or all-cause mortality (rate ratios for ACEIs vs other antihypertensive 
medications ​= ​0.98, 95% CI: 0.88, 1.08; ARBs vs others ​= ​1.00, 95% CI: 0.90, 
1.11) after applying inverse probability of treatment weights. These 
associations were consistent across racial/ethnic groups. Use of ACEIs or ARBs 
during hospitalization was associated with a lower risk of all-cause mortality 
(odds ratios for ACEIs or ARBs vs others ​= ​0.50, 95% CI: 0.34, 0.72).
CONCLUSION: Our study findings support continuation of ACEI or ARB use for 
patients with hypertension during the COVID-19 pandemic and after COVID-19 
infection.