The effect of pre-hospital use of renin-angiotensin system (RAS) inhibitors (ACEis/ARBs) on clinical outcomes of hypertensive patients with COVID-19 has been questioned due to conflicting reports on this issue. After applying exclusion criteria, 175 COVID-19 hospitalized patients admitted to the Tishreen Hospital from 1 January to 31 July 2021were retrospectively enrolled in this study. Baseline characteristics and in-hospital mortality rate were assessed between hypertensive (N=91, 52%) and non-hypertensive (N=84, 48%) patients, as well as between patients taking ACEis/ARBs and non-ACEis/ARBs within the hypertensive group. A lower mortality rate (51.2% vs. 31.9%, p=0.009) was observed in the hypertensive group (Mean age 64.6 years, 64.8% males) compared to the non-hypertensive (Mean age 62.6 years, 66.7% males). Patients' mortality in the non-hypertensive group was associated with lower blood-oxygen saturation (SPO2= 75% vs. 86%, p=0.002), and increased levels of inflammatory (CRP, WBC and neutrophils count) and tissue/renal injury markers (LDH, urea and creatinine). In the hypertensive group, a lower mortality rate was noted in the ACEis/ARBs group compared to the non-ACEis/ARBs (24.1% vs. 45.5%, p=0.036), and this was associated with a decrease in D-DIMER levels, although not significant (1723 vs. 2683 ng/ml, p˃0.05). Death in the non-ACEis/ARBs group was associated with decreased SPO2 and tissue/renal injury markers (LDH, CK, AST, urea and creatinine). We concluded that hypertension is not a direct cause of poor prognosis in COVID-19 patients, and that multi-organ damage is a significant indicator of death from COVID-19. RAS inhibitors could improve survival of hypertensive COVID-19 patients.