Confirmed: Key heart medications safe to use for COVID-19 patients

Heart patients hospitalized with COVID-19 can continue taking angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), according to new findings presented at ESC Congress 2020.

There were some concerns early on about how these medications—often used to treat heart failure, hypertension and other cardiovascular indications—might impact COVID-19 patients, but medical societies have been encouraging patients to continue taking them since the pandemic began. For example, the American Heart Association, Heart Failure Society of America and American College of Cardiology published a joint statement urging patients to keep taking ACE inhibitors and ARBs back on March 17. The British Heart Foundation, meanwhile, shared its own statement on the subject the very next day.

The findings presented at ESC Congress 2020 come courtesy of the BRACE CORONA Trial, a phase 4 randomized study that explored data from 659 patients in Brazil. All patients were already taking either an ACE inhibitor or ARB before being hospitalized with COVID-19. Patients were randomly chosen to follow one of two paths: keep taking the medication like normal or stop taking it for 30 days.

Patients who were already taking more than three antihypertensive drugs—or taking sacubitril/valsartan—were excluded from the trial.

Overall, the average number of days alive and out of the hospital for patients who stopped taking their heart medication was 21.9. The average for patients who kept taking the medication, meanwhile, was 22.9 days. Also, the percentage of patients alive and out of the hospital after 30 days was 91.8% for the group that stopped taking their medication and 95% for the group that kept taking it. Patients in the two groups had a similar 30-day mortality rate.

“This is the first randomized data assessing the role of continuing versus stopping ACE inhibitors and ARBs in patients with COVID-19,” principal investigator Renato Lopes, MD, PhD, of the Duke Clinical Research Institute in Durham, North Carolina, said in a statement. “In patients hospitalized with COVID-19, suspending ACE inhibitors and ARBs for 30 days did not impact the number of days alive and out of hospital. Because these data indicate that there is no clinical benefit from routinely interrupting these medications in hospitalized patients with mild to moderate COVID-19, they should generally be continued for those with an indication.”

ESC Congress 2020 is completely digital due to the COVID-19 pandemic. More information from the European Society of Cardiology is available here.