First randomised trial suggests heart patients with COVID-19 can continue taking ACE inhibitors, ARBs

A report presented at the ESC (European Society of Cardiology) Conference 2020 suggests that heart patients with COVID-19 can safely continue to take ACE inhibitors and Angiotensin receptor blockers (ARBs).

SARS-CoV-2, the causative agent of COVID-19, enters host cells through ACE2 receptors (a close relative to ACE). Research suggests that these receptors are present in various tissues in the body including the lungs, nose, heart and kidneys.

ACE inhibitors and ARBs are drugs that are used to manage blood pressure and treat heart failure. However, previous studies had indicated that regular consumption of these drugs increases the expression of ACE2 receptors on healthy cells. The COVID-19 causing virus can take advantage of this increase and infect more cells quickly.

To understand the effect of ACE2 inhibitors and ARBs at the time of COVID-19 infection, a group of researchers at the Brazillian Clinical Research Institute are currently conducting randomised phase 4 clinical trials under the name BRACE Corona.

The final results of the study are expected to be released in December 2020.

ACE inhibitors and ARBs 

ACE and ACE2 are two proteins that are part of the RAAS (Renin Angiotensin Aldosterone System) in the body. RAAS is responsible for maintaining blood pressure, fluid and electrolyte balance in the body.

Renin, angiotensin and aldosterone are three hormones that are released by various organs in our body.

When you have low blood pressure, your kidneys release renin to convert the protein angiotensin into angiotensin I. The latter is an inactive protein which is activated by angiotensin-converting enzyme (ACE) and converted into angiotensin II. Angiotensin II then constricts blood vessels (vasoconstriction) and increases blood pressure.

So in case of high blood pressure, ACE inhibitors would help control the condition.

ARBs, on the other hand, block the receptors of angiotensin II on blood vessels so it can’t lead to vasoconstriction and raise blood pressure.

ACE2 is the other arm of RAAS. When the blood pressure is high, ACE2 converts angiotensin II into angiotensin (1-7), which then dilates blood vessels and reduces blood pressure.

The study

In the latest study, researchers enrolled about 659 COVID-19 patients at over 29 different sites in Brazil. All of these patients have been using ACE inhibitors or ARBs for a long time. They were randomly divided into two groups - one group was asked to continue taking their medications while the other group was asked to stop taking the medicines. Results were to be noted after a period of 30 days. Here is what was found:

• Those who stopped using ACE inhibitors or ARBs were discharged within 21.9 days, while those who continued using the drugs took 22.9 days to get discharged.
• About 91.8 percent of patients in the first group were discharged and alive at the end of 30 days while about 95 percent of those who continued medications got discharged by the end of the same period.
• Over 2.8 percent of people in the continuation group died in the 30 day period while about 2.7 percent of the other group died during the study period.

“In patients hospitalised 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 hospitalised patients with mild to moderate COVID-19, they should generally be continued for those with an indication,” said Dr Renato Lopes, the chief investigator of the study and a professor of medicine at the Duke Clinical Research Institute, US, in a news release by the European Society of Cardiology

For more information, read our article on Why coronavirus affects lungs.

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