COVID-19: Continuing versus suspending ACE inhibitors and ARBs

 

Heart patients hospitalised with COVID-19 can safely continue ACE inhibitors and ARBs. The phase 4 BRACE CORONA trial showed that suspending these drugs for 30 days did not impact the number of days alive and out of hospital at 30 days compared with continuation of these drugs [1].

There is conflicting observational data available about the potential impact of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) in patients with COVID-19. On the one hand, preclinical research has raised concerns about their safety in patients with COVID-19, because ACE inhibitors and ARBs could increase ACE2 receptor expression and enhance viral entry, leading to worse outcomes. On the other hand, preliminary data has suggested that renin-angiotensin-aldosterone system (RAAS) inhibitors could benefit patients with COVID-19 by decreasing acute lung damage and preventing pulmonary inflammation. In addition, the expression of membrane-bound ACE2, the functional receptor for the SARS-CoV-2 virus, may increase due to upregulation in patients using ACE inhibitors and ARBs.

The phase 4, randomised BRACE CORONA trial enrolled 659 hospitalised adult patients who used ACE inhibitors or ARBs and had a confirmed diagnosis of COVID-19 and compared 2 strategies: suspending or continuing these drugs for 30 days. The results were presented by Prof. Renato Lopes (Duke University, USA).

The primary outcome, the number of days alive and out of hospital at 30 days, was 21.9 days in patients who suspended ACE inhibitors and ARBs and 22.9 days in patients who continued these drugs. The proportion of patients alive and out of hospital by the end of 30 days was 91.8% in the suspending group, and 95% in the continuing group. A similar 30-day mortality rate was seen (2.8% vs 2.7%, respectively; HR 0.97).

This is the first randomised trial comparing the impact of continuing and suspending ACE inhibitors and ARBs in patients hospitalised with COVID-19. In these patients, suspending these drugs for 30 days did not impact the number of days alive and out of hospital. Because these data indicate that there is no clinical benefit from routinely interrupting these medications in hospitalised patients with mild-to-moderate COVID-19, they should generally be continued for those with an indication.

 

1. 
   
   1. Lopes R. BRACE CORONA: Continuing vs. Suspending ACE Inhibitors and ARBs in COVID-19. Hot Line 4 session, ESC Congress 2020, 31 Aug.

 



Posted on 5 November 202023 February 2021