Continuing Versus Suspending Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers - BRACE CORONA

Contribution To Literature:

The BRACE CORONA trial showed that suspending ACEI/ARB did not improve days alive and out of the hospital. 


The goal of the trial was to evaluate suspending compared with continuing angiotensin-converting enzyme inhibitors (ACEI)/angiotensin-receptor blockers (ARB) among patients hospitalized with coronavirus disease 2019 (COVID-19) infection.

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
  • Percentage 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)


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.


Presented by Dr. Renato D. Lopes at the European Society of Cardiology Virtual Congress, September 1, 2020.

Clinical Topics: COVID-19 Hub, Prevention

Keywords: ESC Congress, ESC20, Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Coronavirus, COVID-19, Length of Stay, Secondary Prevention, severe acute respiratory syndrome coronavirus 2

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