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.

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

de Souza, Andrea Silvestre

de Albuquerque, Denilson Campos

Mazza, Lilian

Santos, Mayara Fraga

Salvador, Natalia Zerbinatti

Gibson, C Michael

Granger, Christopher B

Alexander, John H

de Souza, Olga Ferreira

BRACE CORONA investigators

2021-05-10T18:09:49Z

2021-05-10T18:09:49Z

2020-08

2021-05-10T18:09:48Z

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.

S0002-8703(20)30138-1

0002-8703

1097-6744

https://hdl.handle.net/10161/22867

eng

American heart journal

10.1016/j.ahj.2020.05.002

BRACE CORONA investigators

Humans

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

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.

Journal article

Lopes, Renato D|0000-0003-2999-4961

Granger, Christopher B|0000-0002-0045-3291

Alexander, John H|0000-0002-1444-2462

49

59

School of Medicine

Duke Clinical Research Institute

Medicine, Cardiology

Duke

Institutes and Centers

Medicine

Clinical Science Departments

Nursing

School of Nursing

Published

226