Severity of COVID-19 infection in ACEI/ARB users in specialty hospitals: A retrospective cohort study

Ahmed A. Alrashed, Tahir M. Khan, Noara K. Alhusseini, Syed Mohammed Basheeruddin Asdaq, Mushira Enani, Bandar Alosaimi, Nada M. Alkhani, Yahya Mohzari, Maram M. Alghalbi, Wafa Alfahad, Mona A. Alanazi, Asma S. Albujaidya, Amal Ben-Akresh, Malak Almutairi, Ivo Abraham, Ahmad Alamer

Research output: Contribution to journalArticlepeer-review


Background: The uncertainty about COVID-19 outcomes in angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) users continues with contradictory findings. This study aimed to determine the effect of ACEI/ARB use in patients with severe COVID-19. Methods: This retrospective cohort study was done in two Saudi public specialty hospitals designated as COVID-19 referral facilities. We included 354 patients with a confirmed diagnosis of COVID-19 between April and June 2020, of which 146 were ACEI/ARB users and 208 were non-ACEI/ARB users. Controlling for confounders, we conducted multivariate logistic regression and sensitivity analyses using propensity score matching (PSM) and Inverse propensity score weighting (IPSW) for high-risk patient subsets. Results: Compared to non-ACEI/ARB users, ACEI/ARB users had an eight-fold higher risk of developing critical or severe COVID-19 (OR = 8.25, 95%CI = 3.32–20.53); a nearly 7-fold higher risk of intensive care unit (ICU) admission (OR = 6.76, 95%CI = 2.88–15.89) and a nearly 5-fold higher risk of requiring noninvasive ventilation (OR = 4.77,95%CI = 2.15–10.55). Patients with diabetes, hypertension, and/or renal disease had a five-fold higher risk of severe COVID-19 disease (OR = 5.40,95%CI = 2.0−14.54]. These results were confirmed in the PSM and IPSW analyses. Conclusion: In general, but especially among patients with hypertension, diabetes, and/or renal disease, ACEI/ARB use is associated with a significantly higher risk of severe or critical COVID-19 disease, and ICU care.

Original languageEnglish (US)
Pages (from-to)726-733
Number of pages8
JournalJournal of Infection and Public Health
Issue number6
StatePublished - Jun 2021


  • Angiotensin II receptor blocker
  • Angiotensin-converting enzyme inhibitor
  • COVID-19
  • Disease severity
  • Hospital admission
  • Mortality
  • Saudi Arabia

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


Dive into the research topics of 'Severity of COVID-19 infection in ACEI/ARB users in specialty hospitals: A retrospective cohort study'. Together they form a unique fingerprint.

Cite this