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Effect of the renin–angiotensin–aldosterone system inhibitors on time to nucleic acid negative conversion in hypertensive patients with SARS-CoV-2 omicron infection: a propensity score matching study

Hypertension Research volume 48, pages 273–283 (2025)Cite this article

A Correction to this article was published on 03 October 2025

A Comment to this article was published on 28 January 2025

This article has been updated

Abstract

We examined the relationship between RAAS inhibitor use and Omicron infection in mildly symptomatic patients. This retrospective case-control observational study included 50,121 patients with mild Omicron infection from the largest “Fangcang” shelter hospital in Shanghai between April 9, 2022, and May 21, 2022. Using 1:1 propensity score matching (PSM), we classified 4394 COVID-19 patients into hypertension and non-hypertension groups, and 406 hypertensive patients into RAAS inhibitor and non-RAAS inhibitor groups. The risk of initial symptoms of infection, cumulative negative conversion rates, time to nucleic-acid negative conversion, and viral loads were compared. In the hypertension group, the median number of days for nucleic-acid negative conversion was 7.0 (IQR, 5.0–9.0), which was greater than non-hypertensive group (median (IQR) 6.0 (4.0–8.0), P < 0.001, Cohen’s d = 0.29); the mean and minimum cycle threshold values (CT-values) were significantly lower (P < 0.001, Cohen’s d = 0.23). In the RAAS inhibitors group, the median number of days for nucleic-acid negative conversion was 7.0 days (IQR, 5.0–9.0), which was shorter than the non-RAAS inhibitors group ([median (IQR)] 8.0 (6.0–10.0), P < 0.001, Cohen’s d = 0.34), the cumulative negative conversion rates at 3–8 days being all higher than non-RAAS inhibitors groups (P < 0.05). The most significant difference in negative conversion rate between the RAAS inhibitor and non-RAAS inhibitor group was on the 4th day. No significant difference was observed in mean and minimum CT-values from RAAS inhibitor and non-RAAS inhibitor groups (P > 0.05). RAAS inhibitor use in patients with hypertension is associated with nucleic-acid negative conversion duration and negative conversion rate. RAAS inhibitors clearly do not aggravate or prolong COVID-19.

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Change history

  • 03 October 2025

    The original online version of this article was revised: Author name spelling has been corrected. In the article “Effect of the renin–angiotensin–aldosterone system inhibitors on time to nucleic acid negative conversion in hypertensive patients with SARS-CoV-2 omicron infection: a propensity score matching study” by Ru Wen et al., published in Hypertension Research (2025, 48:273–283), the name of the second author was incorrectly spelled as “Jinwen Li.” The correct spelling is “Jingwen Li.” The authors apologize for this error. The original article has been corrected.

  • 03 October 2025

    A Correction to this paper has been published: https://doi.org/10.1038/s41440-025-02386-7

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Acknowledgements

Thanks to the doctors and nurses in the anti-epidemic front line who participated in the data collection.

Funding

This study has received funding from Boqing Innovation Fund of the First Affiliated Hospital of Army Military Medical University (grant No. 2024BQCXJJ-8), Emergency Project for Technological Breakthrough in Clinical Treatment of Hospital-acquired COVID-19 Infection in 2023(2023XGIIT07), and Young and Middle-aged Medical Talents Foundation Project of Chongqing (Grant No. 414Z395).

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Author notes

  1. These authors contributed equally: Ru Wen, Jingwen Li, Fengxi Chen

Authors and Affiliations

  1. Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China

    Ru Wen, Fengxi Chen, Peng Xu, Mengfei Li & Chen Liu

  2. Department of Medical Imaging, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, China

    Ru Wen & Jian Liu

  3. Department of Gastroenterology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China

    Jingwen Li

  4. Department of Cardiology, Xinqiao Hospital, Army Military Medical University, Chongqing, China

    Jingwei Li

  5. The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia

    Jingwei Li

  6. Department of Critical Care Medicine, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China

    Liang Tan

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The original online version of this article was revised: Author name spelling has been corrected. In the article “Effect of the renin–angiotensin–aldosterone system inhibitors on time to nucleic acid negative conversion in hypertensive patients with SARS-CoV-2 omicron infection: a propensity score matching study” by Ru Wen et al., published in Hypertension Research (2025, 48:273–283), the name of the second author was incorrectly spelled as “Jinwen Li.” The correct spelling is “Jingwen Li.” The authors apologize for this error. The original article has been corrected.

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Wen, R., Li, J., Chen, F. et al. Effect of the renin–angiotensin–aldosterone system inhibitors on time to nucleic acid negative conversion in hypertensive patients with SARS-CoV-2 omicron infection: a propensity score matching study. Hypertens Res 48, 273–283 (2025). https://doi.org/10.1038/s41440-024-01953-8

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