BRACE CORONA: Does Temporarily Suspending RAAS Inhibitors Show Clinical Benefit in Hospitalized COVID-19 Patients?

Temporarily suspending use of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) did not show clinical benefit in patients hospitalized with mild to severe COVID-19, according to findings from the BRACE CORONA trial presented at ESC Congress 2020.

Researchers enrolled 659 patients chronically using an ACE inhibitor or ARB from 29 sites in Brazil who were hospitalized with COVID-19. These patients were randomly allocated to stopping the ACE inhibitor/ARB for 30 days or continuing the ACE inhibitor/ARB. The primary outcome was the number of days alive and out of hospital at 30 days. Of note, patients using more than three antihypertensive drugs, using sacubitril/valsartan, or who were hemodynamically unstable at presentation were excluded from the study.

Findings showed the average number of days alive and out of hospital was 21.9 days for patients who stopped ACE inhibitors/ARBs and 22.9 days for patients who continued these medications. The average ratio of days alive and out of hospital between the suspending and continuing groups was 0.95 (95% confidence interval [CI] 0.90 to 1.01, p=0.09). The average difference between groups was -1.1 days (95% CI -2.33 to 0.17).  The proportion of patients alive and out of hospital by the end of 30 days in the ACE inhibitor/ARB suspension group was 91.8% compared with 95% in the continuing group. Additionally, a similar 30-day mortality rate was seen for patients who continued and suspended the ACE inhibitor/ARB (2.8% vs. 2.7%, respectively).

"This is the first randomized data assessing the role of continuing versus stopping ACE inhibitors and ARBs in patients with COVID-19," said principal investigator Renato Lopes, MD, PhD, FACC, of Duke Clinical Research Institute, Durham, NC. "Because these data indicate that there is no clinical benefit from routinely interrupting these medications in hospitalized patients with mild to moderate COVID-19, they should generally be continued for those with an indication."

Clinical Topics: COVID-19 Hub, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention

Keywords: ESC Congress, ESC20, Dyslipidemias, Primary Prevention, COVID-19, Coronavirus

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