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.
- Lopes R. BRACE CORONA: Continuing vs. Suspending ACE Inhibitors and ARBs in COVID-19. Hot Line 4 session, ESC Congress 2020, 31 Aug.
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Table of Contents: ESC 2020
Featured articles
2020 ESC Clinical Practice Guidelines
2020 Atrial Fibrillation Guidelines
2020 Non-ST-Segment Elevation Acute Coronary Syndromes Guidelines
2020 Sports Cardiology and Exercise in Cardiovascular Patients Guidelines
2020 Adult Congenital Heart Disease Guidelines
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First-in-class cardiac myosin inhibitor effective in obstructive hypertrophic cardiomyopathy
Reduced cardiovascular outcomes with early rhythm control
Trimetazidine after successful PCI not associated with fewer cardiac events
POPular TAVI: Aspirin-only antiplatelet strategy?
Reduced NT-proBNP in HFpEF with sacubitril/valsartan
DAPA-CKD: Dapagliflozin improves CKD survival ± diabetes
Low-dose colchicine reduces CV death and ischaemic events in coronary disease
Similar outcomes sPESI and HESTIA for pulmonary embolism triage
Antihypertensives also reduce CV risk in people with normal blood pressure
COVID-19: Continuing versus suspending ACE inhibitors and ARBs
Drug initiation strategy not associated with increased use of oral anticoagulants
Restrictive blood transfusion non-inferior and cost-effective strategy
Late-Breaking Science
Increased mortality with colchicine in patients with ACS
Rivaroxaban protects limbs and ischaemic events in CAD-PAD patients
Antisense APOC3 oligonucleotide lowers triglyceride and atherogenic lipoproteins
Antisense ANGPTL3 lowers triglycerides
Reduced progression of coronary atherosclerosis with icosapent ethyl
Digoxin improves symptoms in stable patients with permanent AF
SGLT2 inhibitor ertugliflozin shows similar mortality but fewer HF hospitalisations
COVID and Cardiovascular Disease
Risk factors for thromboembolism and bleeding in COVID-19: lessons from Wuhan
The Yale COVID-19 Cardiovascular Registry
COVID-19 treatments and the importance of randomised trials
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