Continuing versus suspending angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: Impact on adverse outcomes in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)--The BRACE CORONA Trial.
Abstract
Angiotensin-converting enzyme-2 (ACE2) expression may increase due to upregulation
in patients using angiotensin-converting enzyme inhibitors (ACEI) and angiotensin
receptor blockers (ARBs). Because renin-angiotensin system blockers increase levels
of ACE2, a protein that facilitates coronavirus entry into cells, there is concern
that these drugs could increase the risk of developing a severe and fatal form of
COVID-19. The impact of discontinuing ACEI and ARBs in patients with COVID-19 remains
uncertain. DESIGN: BRACE CORONA is a pragmatic, multicenter, randomized, phase IV,
clinical trial that aims to enroll around 500 participants at 34 sites in Brazil.
Participants will be identified from an ongoing national registry of suspected and
confirmed cases of COVID-19. Eligible patients using renin-angiotensin system blockers
(ACEI/ARBs) with a confirmed diagnosis of COVID-19 will be randomized to a strategy
of continued ACEI/ARB treatment versus temporary discontinuation for 30 days. The
primary outcome is the median days alive and out of the hospital at 30 days. Secondary
outcomes include progression of COVID-19 disease, all-cause mortality, death from
cardiovascular causes, myocardial infarction, stroke, transient ischemic attack, new
or worsening heart failure, myocarditis, pericarditis, arrhythmias, thromboembolic
events, hypertensive crisis, respiratory failure, hemodynamic decompensation, sepsis,
renal failure, and troponin, B-type natriuretic peptide (BNP), N-terminal-proBNP,
and D-dimer levels. SUMMARY: BRACE CORONA will evaluate whether the strategy of continued
ACEI/ARB therapy compared with temporary discontinuation of these drugs impacts clinical
outcomes among patients with COVID-19.
Type
Journal articleSubject
BRACE CORONA investigatorsHumans
Pneumonia, Viral
Coronavirus Infections
Peptidyl-Dipeptidase A
Angiotensin-Converting Enzyme Inhibitors
Withholding Treatment
Virus Integration
Renin-Angiotensin System
Inpatients
Brazil
Multicenter Studies as Topic
Randomized Controlled Trials as Topic
Clinical Trials, Phase IV as Topic
Angiotensin Receptor Antagonists
Pandemics
Pragmatic Clinical Trials as Topic
Betacoronavirus
COVID-19
Angiotensin-Converting Enzyme 2
SARS-CoV-2
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https://hdl.handle.net/10161/22867Published Version (Please cite this version)
10.1016/j.ahj.2020.05.002Publication Info
Lopes, Renato D; Macedo, Ariane Vieira Scarlatelli; de Barros E Silva, Pedro Gabriel
Melo; Moll-Bernardes, Renata Junqueira; Feldman, Andre; D'Andréa Saba Arruda, Guilherme;
... BRACE CORONA investigators (2020). Continuing versus suspending angiotensin-converting enzyme inhibitors and angiotensin
receptor blockers: Impact on adverse outcomes in hospitalized patients with severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2)--The BRACE CORONA Trial. American heart journal, 226. pp. 49-59. 10.1016/j.ahj.2020.05.002. Retrieved from https://hdl.handle.net/10161/22867.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
John Hunter Peel Alexander
Professor of Medicine
John H. Alexander, MD, MHS is a cardiologist and Professor of Medicine in the Department
of Medicine, Division of Cardiology at Duke University School of Medicine, as well
as the Vice Chief, Clinical Research in the Division of Cardiology. He is the Director
of Cardiovascular Research at the Duke Clinical Research Institute where he oversees
a large group of clinical research faculty and a broad portfolio of cardiovascular
clinical trials and observational clinical research programs. He is a
Christopher Bull Granger
Donald F. Fortin, M.D. Distinguished Professor of Medicine
Research: My primary research interest is in conduct and methodology of large randomized
clinical trials in heart disease. I have led a number of large international clinical
studies in heart attacks, unstable angina, heart failure, and atrial fibrillation.
I have lead clinical studies of blood thinners and coronary intervention for heart
attacks, stroke prevention in atrial fibrillation, and prevention of heart attack
for patients with coronary artery disease. I have been co-directo
Renato Delascio Lopes
Professor of Medicine
Atrial Fibrillation Antithrombotic Therapy in patients with Acute Coronary Syndromes
Elderly patients with Heart Disease Biomarkers in Acute Coronary Syndromes and Atrial
Fibrillation Thrombosis and Anticoagulation and novel antithrombotic agents Metabolomics
in Cardiovascular Medicine
Alphabetical list of authors with Scholars@Duke profiles.

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