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).

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

2020-06-01T15:20:45Z

2020-06-01T15:20:45Z

2020-05-13

2020-06-01T15:20:43Z

Background:Angiotensin-converting enzyme-2 (ACE2) may increase due to upregulation in patients using angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB). 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.DESIGNBRACE CORONA is a pragmatic, multicenter, randomized, phase IV, clinical trial that aims to enroll around 500 participants at 32 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 vascular 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, troponin, B-type natriuretic peptide, N-terminal-pro hormone 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/10161/20723

eng

Elsevier BV

American heart journal

10.1016/j.ahj.2020.05.002

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).

Journal article

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

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

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

School of Medicine

Duke Clinical Research Institute

Medicine, Cardiology

Duke

Institutes and Centers

Medicine

Clinical Science Departments

Published