SARS-CoV-2 infection and adverse outcomes in users of ACE inhibitors and angiotensin-receptor blockers: A nationwide case-control and cohort analysis

Christian Fynbo Christiansen*, Anton Pottegård, Uffe Heide-Jørgensen, Jacob Bodilsen, Ole Schmeltz Søgaard, Michael Maeng, Simon Tilma Vistisen, Morten Schmidt, Lars Christian Lund, Mette Reilev, Jesper Hallas, Marianne Voldstedlund, Anders Husby, Marianne Kragh Thomsen, Nanna Borup Johansen, Nikolai Constantin Brun, Reimar Wernich Thomsen, Hans Erik Bøtker, Henrik Toft Sørensen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review


Objective To examine the impact of ACE inhibitor (ACE-I)/angiotensin receptor blocker (ARB) use on rate of SARS-CoV-2 infection and adverse outcomes. Methods This nationwide case-control and cohort study included all individuals in Denmark tested for SARS-CoV-2 RNA with PCR from 27 February 2020 to 26 July 2020. We estimated confounder-adjusted ORs for a positive test among all SARS-CoV-2 tested, and inverse probability of treatment weighted 30-day risk and risk ratios (RRs) of hospitalisation, intensive care unit (ICU) admission and mortality comparing current ACE-I/ARB use with calcium channel blocker (CCB) use and with non-use. Results The study included 13 501 SARS-CoV-2 PCR-positive and 1 088 695 PCR-negative individuals. Users of ACE-I/ARB had a marginally increased rate of a positive PCR when compared with CCB users (aOR 1.17, 95% CI 1.00 to 1.37), but not when compared with non-users (aOR 1.00 95% CI 0.92 to 1.09). Among PCR-positive individuals, 1466 (11%) were ACE-I/ARB users. The weighted risk of hospitalisation was 36.5% in ACE-I/ARB users and 43.3% in CCB users (RR 0.84, 95% CI 0.70 to 1.02). The risk of ICU admission was 6.3% in ACE-I/ARB users and 5.4% in CCB users (RR 1.17, 95% CI 0.64 to 2.16), while the 30-day mortality was 12.3% in ACE-I/ARB users and 13.9% in CCB users (RR 0.89, 95% CI 0.61 to 1.30). The associations were similar when ACE-I/ARB users were compared with non-users. Conclusions ACE-I/ARB use was associated neither with a consistently increased rate nor with adverse outcomes of SARS-CoV-2 infection. Our findings support the current recommendation of continuing use of ACE-Is/ARBs during the SARS-CoV-2 pandemic. Trial registration number EUPAS34887

Original languageEnglish
Issue number4
Pages (from-to)370-379
Publication statusPublished - 15. Mar 2021


  • clinical epidemiology
  • critical care
  • respiratory infection
  • viral infection


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