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

Sep 01, 2020
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Presenter/Author:
Renato D. Lopes, MD, PhD, FACC
Author/Summarized by Author:
Anthony A. Bavry, MD, MPH, FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
D'Or Institute for Research and Education and Brazilian Clinical Research Institute
Date Presented:
09/01/2020
Date Updated:
09/01/2020
Original Posted Date:
09/01/2020
References

Contribution To Literature:

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

Description:

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)

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.

References:

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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