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31 reviewsAbstractAngiotensin-converting enzyme 2 (ACE2) is required for the cellular entry of the severe acute respiratory syndrome coronavirus2. ACE2, via the Ang-(1-7)-Mas-R axis, is part of the antihypertensive and cardioprotective effects of the renin-angiotensinsystem. We studied hospitalized COVID-19 patients with hypertension and hypertensive human(h) ACE2 transgenic mice todetermine the outcome of COVID-19 with or without AT1 receptor (AT1R) blocker treatment. The severity of the illness and thelevels of serum cardiac biomarkers (CK, CK-BM, cTnI), as well as the inflammation markers (IL-1, IL-6, CRP), were lesser inhypertensive COVID-19 patients treated with AT1R blockers than those treated with other antihypertensive drugs. HypertensivehACE2 transgenic mice, pretreated with AT1R blocker, had increased ACE2 expression and SARS-CoV-2 in the kidney andheart, 1 day post-infection. We conclude that those hypertensive patients treated with AT1R blocker may be at higher risk forSARS-CoV-2 infection. However, AT1R blockers had no effect on the severity of the illness but instead may have protectedCOVID-19 patients from heart injury, via the ACE2-angiotensin1-7-Mas receptor axis.Keywords Coronavirus disease 2019 . Hypertension . AT1Abbreviationsreceptor blocker . Angiotensin converting enzyme 2Ang1-7 Angiotensin 1–7Ang Angiotensin