{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T10:38:44Z","timestamp":1790419124490,"version":"4.1.0"},"reference-count":25,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2020,11,24]],"date-time":"2020-11-24T00:00:00Z","timestamp":1606176000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006016","name":"College of Medicine, King Saud University","doi-asserted-by":"crossref","award":["CMRC-20-08?"],"award-info":[{"award-number":["CMRC-20-08?"]}],"id":[{"id":"10.13039\/501100006016","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Cardiovasc Pharmacol Ther"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Speculations whether treatment with angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARB) predisposes to severe coronavirus disease 2019 (COVID-19) or worsens its outcomes. This study assessed the association of ACE-I\/ARB therapy with the development of severe COVID-19.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This multi-center, prospective study enrolled patients hospitalized for COVID-19 and receiving one or more antihypertensive agents to manage either hypertension or cardiovascular disease. ACE-I\/ARB therapy associations with severe COVID-19 on the day of hospitalization, intensive care unit (ICU) admission, mechanical ventilation and in-hospital death on follow-up were tested using a multivariate logistic regression model adjusted for age, obesity, and chronic illnesses. The composite outcome of mechanical ventilation and death was examined using the adjusted Cox multivariate regression model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of 338 enrolled patients, 245 (72.4%) were using ACE-I\/ARB on the day of hospital admission, and 197 continued ACE-I\/ARB therapy during hospitalization. Ninety-eight (29%) patients had a severe COVID-19, which was not significantly associated with the use of ACE-I\/ARB (OR 1.17, 95% CI 0.66-2.09; P = .57). Prehospitalization ACE-I\/ARB therapy was not associated with ICU admission, mechanical ventilation, or in-hospital death. Continuing ACE-I\/ARB therapy during hospitalization was associated with decreased mortality (OR 0.22, 95% CI 0.073-0.67; P = .008). ACE-I\/ARB use was not associated with developing the composite outcome of mechanical ventilation and in-hospital death (HR 0.95, 95% CI 0.51-1.78; P = .87) versus not using ACE-I\/ARB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Patients with hypertension or cardiovascular diseases receiving ACE-I\/ARB therapy are not at increased risk for severe COVID-19 on admission to the hospital. ICU admission, mechanical ventilation, and mortality are not associated with ACE-I\/ARB therapy. Maintaining ACE-I\/ARB therapy during hospitalization for COVID-19 lowers the likelihood of death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration:<\/jats:title>\n                    <jats:p>ClinicalTrials.gov, NCT4357535.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1074248420976279","type":"journal-article","created":{"date-parts":[[2020,11,24]],"date-time":"2020-11-24T14:46:25Z","timestamp":1606229185000},"page":"244-252","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":15,"title":["Association of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Blockers With Severity of COVID-19: A Multicenter, Prospective Study"],"prefix":"10.1177","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6979-0966","authenticated-orcid":false,"given":"Hakeam A.","family":"Hakeam","sequence":"first","affiliation":[{"name":"Pharmaceutical Care, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia"},{"name":"College of Medicine, Alfaisal University, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3181-4261","authenticated-orcid":false,"given":"Muhannad","family":"Alsemari","sequence":"additional","affiliation":[{"name":"Department of Surgery, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zainab Al","family":"Duhailib","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada"},{"name":"Critical Care Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8850-1384","authenticated-orcid":false,"given":"Leen","family":"Ghonem","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Clinical Pharmacy Services, King Saud University Medical City, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saad A.","family":"Alharbi","sequence":"additional","affiliation":[{"name":"Pharmacy Services, Buriadh Central Hospital, Buriadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eid","family":"Almutairy","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nader M. Bin","family":"Sheraim","sequence":"additional","affiliation":[{"name":"Pharmacy Service, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meshal","family":"Alsalhi","sequence":"additional","affiliation":[{"name":"Pharmacy Services, Buriadh Central Hospital, Buriadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Alhijji","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"AlQahtani","sequence":"additional","affiliation":[{"name":"Pharmacy Service, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Khalid","sequence":"additional","affiliation":[{"name":"Pulmonary Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2274-007X","authenticated-orcid":false,"given":"Mazin","family":"Barry","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2020,11,24]]},"reference":[{"key":"bibr1-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1038\/s41564-020-0695-z"},{"key":"bibr2-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30183-5"},{"issue":"18","key":"bibr3-1074248420976279","first-page":"1775","volume":"323","author":"Onder G","year":"2020","journal-title":"JAMA"},{"key":"bibr4-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2020.02.052"},{"key":"bibr5-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvaa097"},{"key":"bibr6-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa329"},{"key":"bibr7-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.104.510461"},{"key":"bibr8-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1093\/ajh\/hpu086"},{"key":"bibr9-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2020.04.013"},{"key":"bibr10-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.11301"},{"key":"bibr11-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2020-317393"},{"issue":"18","key":"bibr12-1074248420976279","first-page":"1769","volume":"323","author":"Patel AB","year":"2020","journal-title":"JAMA"},{"key":"bibr13-1074248420976279","volume-title":"Clinical Management of Severe Acute Respiratory Infection (SARI) when COVID-19 Disease Is Suspected","author":"WHO","year":"2020"},{"key":"bibr14-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.2033"},{"key":"bibr15-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1159\/000339789"},{"key":"bibr16-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2020.104370"},{"key":"bibr17-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.120.317134"},{"key":"bibr18-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1038\/nm1267"},{"key":"bibr19-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2020.06.047"},{"key":"bibr20-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30309-0"},{"key":"bibr21-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1177\/1074248420947628"},{"key":"bibr22-1074248420976279","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.11122"},{"issue":"3","key":"bibr23-1074248420976279","first-page":"547","volume":"5","author":"Sadjadi SA","year":"2009","journal-title":"Ther Clin Risk Manag"},{"key":"bibr24-1074248420976279","unstructured":"Saudi Center for Disease Prevention and Control. 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