Continuing versus suspending ACEi and ARBs in COVID-19
BRACE CORONA: Continuing vs. Suspending ACE Inhibitors and ARBs in COVID-19
Presented at the ESC congress 2020 by: Prof. Renato D. Lopes, MD, PhD (Durham, NC, USA)
Introduction and methods
There have been conflicting hypotheses about the potential impact of ACEi and ARBs in patients with COVID-19. On the one hand, it has been hypothesized that RAAS inhibition could be harmful in COVID-19 patients. ACEi and ARBs could increase ACE2 receptor expression and enhance viral entry leading to worse outcomes in COVID-19 patients. On the other hand, it has been hypothesized that RAAS inhibition is protective. The rationale behind this hypothesis is that diminished production of angiotensin II with ACEi or ARBs enhances the generation of angiotensin (1-7), which reduces inflammation and fibrosis and could reduce lung injury.
The BRACE CORONA trial was a multicenter, randomized clinical trial that randomly allocated 659 hospitalized patients (≥18 years of age) with a confirmed diagnosis of COVID-19 and who used ACEi or ARBs to one of two strategies: 1) suspension of ACEi/ARB treatment for 30 days or 2) continued use of ACEi/ARBs. Patients who were hospitalized due to decompensated HF in the last 12 months, who used >3 anti-hypertensive drugs, who used sacubitril/valsartan or who were hemodynamically unstable at presentation were excluded from the study. The primary outcome was the number of days alive and out of hospital at 30 days.
- The mean days (± SD) alive and out of hospital at 30 days was 21.9±8.0 in patients who suspended ACEi/ARBs and 22.9±7.1 in patients who continued these medications.
- The mean ratio of days alive and out of hospital between the suspending and continuing groups was 0.95 (95%CI 0.90-1.01, P=0.09). The mean difference between the suspending and continuing groups was -1.1 days (95%CI -2.33 to 0.17).
- The proportion of patients alive and out of hospital by the end of 30 days was 91.8% in the suspending ACEi/ARB group, and 95% in the continuing group.
This randomized trial provided evidence that suspension ACEi/ARB therapy for 30 days in COVID-19 patients did not impact the number of days alive and out of hospital at 30 days compared with continued use of ACEi/ARB therapy.
-Our reporting is based on the information provided at the ESC congress-