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Covid-19 Primary Care Resources

ACE Inhibitors and ARBs

Elderly discharged

A summary of relevant guidance and emerging evidence for primary care

This information is sourced from JAMA, NICE, The Renal Association, and the Centre for Evidence-Based Medicine (CEBM):

Studies published in JAMA on 19 June 2020:

  • A retrospective cohort study of 4480 patients diagnosed with Covid-19 found prior ACEI/ARB use was not significantly associated with mortality
  • A nested case-control study of a cohort of 494,170 patients with hypertension found ACEI/ARB were not associated with a significantly increased risk of Covid-19, when compared with other antihypertensives.

The article concludes that any prior use of ACEI/ARB was not significantly associated with Covid-19 diagnosis or with mortality among patients diagnosed as having Covid-19

Prior to these studies:

A rapid evidence summary from NICE on 21 May 2020 said that conclusions cannot be drawn on whether ACEIs or ARBs increase the risk of developing Covid-19 or Covid-19 severity

The Renal Association guidance currently states:

  • People taking ACEi/ARBs should to continue to take them
  • GPs can use an a guideline to aid decisions for patients using ACEI/ARB medications and presenting with Acute Kidney Injury (AKI) or worsening renal function

The CEBM guidance (as correct on 23 March 2020):

  • The benefits vs harms of ACE Inhibitors or ARBs during an episode of infection with SARS-CoV-2 is unclear
  • GPs can use another flow diagram for reviewing ACEi/ARBs in advance of an infection, during an infection with Covid-19 or when recovered, for different groups of patients


Management of patients with AKI or reasonable renal function who are receiving RAAS inhibitor

Any patient taking on ACE-1 inhibitor or an ARB