Duke Scientist: Patients With COVID-19 Should Stay on ACE Inhibitors, ARBs

A study from the European Society of Cardiology answers a question about COVID-19: should patients keep taking well-known heart medications?

Heart patients can safely keep taking angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) if they are hospitalized with coronavirus disease 2019 (COVID-19), based on findings from the first randomized trial to study this issue.

Data from the BRACE CORONA trial, presented Tuesday during the European Society of Cardiology meeting, found no difference between patients who kept taking their ACE inhibitors or ARBs and those who stopped taking them for 30 days after being diagnosed with COVID-19. The study, led by Renato Lopes, MD, PhD, of the Duke Clinical Research Institute, Durham, North Carolina, involved 659 patients at 29 sites in Brazil.

Patients were followed for 30 days after diagnosis. Results showed that the average number of days alive and out of hospital was 21.9 for patients who stopped their medication 22.9 for patients who continued them; the average difference in clinical status at 30 days between groups was -1.1 days.

“This is the first randomized data assessing the role of continuing versus stopping ACE inhibitors and ARBs in patients with COVID-19,” said Lopes. “Because these data indicate that there is no clinical benefit from routinely suspending these medications in hospitalized patients with mild to moderate COVID-19, they should be generally continued for those with an indication.”

The results confirm the early recommendations from major professional societies that patients should keep taking their medications, he said.

Since the COVID-19 pandemic began, clinicians have grappled with the question of whether to continue giving patients these medications. Associations between angiotensin-converting enzyme 2 (ACE2) and SARS-CoV-2 were a concern, as ACE2 was seen as a port of entry for the virus that causes COVID-19, and thus could make COVID-19 more dangerous in some patients. Yet other evidence suggested that renin-angiotensin-aldosterone system inhibitors could reduce acute lung damage from COVID-19.

Researchers excluded patients who were using more than 3 antihypertensive drugs, or sacubitril/valsartan, or who were hemodynamically unstable at hospital admission.

Lopes told reporters during a press briefing that the trial also examined several secondary end points, including myocardial infarction and stroke and how far the disease had progressed, as measured by whether a patient was intubated or in the intensive care unit. “Basically, the results are very consistent,” he said. “We do not see any significant difference between treatment strategies in any of the key secondary end points that were also assessed in the trial.”

More results on subgroup analyses, such as results by age or for obese patients, will be presented later, he said.