Status of ACEI/ARBs in COVID-19 Patients

Written by Todd Tessendorf, MD

During this year’s European Society of Cardiology’s Congress 2020 digital seminar, one of the more timely trials presented was The BRACE CORONA Trial. In the beginning stages of the pandemic, research was pointing toward membrane-bound angiotensin-converting enzyme 2 (ACE2) as a functional receptor for COVID-19. Data collected indicated increased mortality rates from COVID-19 in patients with coronary heart disease, diabetes and hypertension – which lead to some speculation that patients taking ACE inhibitors or angiotensin-receptor blockers were at an increased risk.    

The BRACE CORONA Trial

The goal of this trial was to evaluate suspending compared with continuing angiotensin-converting enzyme inhibitors (ACEI)/angiotensin-receptor blockers (ARB) among patients hospitalized with COVID-19.

Study Design

• Randomized
• Parallel

Eligible patients were randomized to temporary suspension of ACEI/ARB (n = 334) versus continued use of ACEI/ARB (n = 325).

• Total number of enrollees: 659
• Duration of follow-up: 30 days
• Mean patient age: 55 years
• Male: 59% Female: 41%
• Percentage with diabetes: 33%

Inclusion criteria:

• Patients ≥18 years of age
• Hospitalized with COVID-19
• Chronic use of ACEI or ARB

Exclusion criteria:

• Hospitalization due to decompensated heart failure in the last year
• Use of >3 antihypertensive agents
• Use of sacubitril/valsartan
• Hemodynamic instability

Principal Findings:

The primary outcome, number of days alive and out of the hospital through 30 days, was 21.9 in the suspending ACEI/ARB group compared with 22.9 in the continuing ACEI/ARB group (p = 0.09).

Secondary outcomes:

All-cause death at 30 days: 2.7% in the suspending ACEI/ARB group compared with 2.8% in the continuing ACEI/ARB group (p = 0.95)

Interpretation:

Among patients hospitalized with COVID-19 infection and receiving chronic ACEI/ARB, suspending ACEI/ARB was not beneficial. Suspending ACEI/ARB compared with continuing them did not improve the days alive and out of the hospital.

Takeaways

The BRACE CORONA trial findings are supportive in the continuation of ACE inhibitors and ARBs in patients with COVID-19. Given that COVID-19 is challenging to treat and the myriad of patients on ACEI and ARBs, it is extremely beneficial to know that there is currently no need to change these medications during a COVID infection.

If you need screening assistance or help assessing a patient, please call Bryan Heart at 402-483-3333.