One of the earliest questions regarding COVID-19 was whether patients should keep taking blood pressure medications such as angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) as prescribed. The early evidence was mixed—some data suggested those medications could increase the risk of infection or lead to worse outcomes, but other research indicated this was not the case.
Now, as the pandemic continues to impact daily life throughout the world, a research team out of Brazil has investigated this question with a focus on 30-day patient mortality after hospitalization. The group shared its findings in JAMA.
“There are conflicting mechanistic hypotheses and observational findings about the effect of ACE inhibitors and ARBs on patients with COVID-19,” wrote first author Renato D. Lopes, MD, PhD, D’Or Institute for Research and Education in Brazil, and colleagues. “Given the impossibility of obtaining reliable estimates of comparative effectiveness in observational studies, this clinical question needs to be answered in a randomized clinical trial.”
Lopes et al. explored data from more than 600 patients who were hospitalized at one of 35 care facilities in Brazil. All patients were hospitalized from April 9 to June 26, 2020. While 334 patients were randomly selected to discontinue ACE inhibitor/ARB therapy, the remaining patients continued therapy.
“The study protocol did not recommend any specific treatment modification beyond discontinuing or continuing use of ACE inhibitors or ARBs,” the authors wrote. “The study team provided oversight on drug replacement, and those decisions were made based on current treatment guidelines. Patients were treated for COVID-19 according to current local standards of supportive care without the systematic use of investigational therapies. Treatment adherence was assessed based on medical prescriptions recorded in the chart throughout hospitalization and in the electronic health record after discharge.”
Overall, the authors found that there was “no significant difference” in 30-day mortality, cardiovascular mortality or COVID-19 progression between the two patient groups.
Looking at adverse events, the team found that 9.6% of patients in the discontinuation group and 7.7% of the continuation group experienced respiratory failure requiring invasive mechanical ventilation. Acute myocardial infarction occurred in 7.5% of the discontinuation group and 4.6% of the continuation group.
“These findings do not support routinely discontinuing ACE inhibitors or ARBs among patients hospitalized with mild to moderate COVID-19 if there is an indication for treatment,” the authors concluded.
The full study is available here. More recent coverage of this topic can be found here, here, here and here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.