Renin-angiotensin system inhibitor discontinuation in COVID-19 did not modify systemic ACE2 in a randomized controlled trial
oleh: Vincent Rathkolb, Marianna T. Traugott, Andreas Heinzel, Marko Poglitsch, Judith Aberle, Farsad Eskandary, Agnes Abrahamowicz, Martin Mueller, Petra Knollmueller, Tarik Shoumariyeh, Jasmin Stuflesser, Ivan Seeber, Georg Gibas, Hannah Mayfurth, Viktoria Tinhof, Lukas Schmoelz, Markus Zeitlinger, Christian Schoergenhofer, Bernd Jilma, Bernd Genser, Wolfgang Hoepler, Sara Omid, Mario Karolyi, Christoph Wenisch, Rainer Oberbauer, Alexander Zoufaly, Manfred Hecking, Roman Reindl-Schwaighofer
| Format: | Article |
|---|---|
| Diterbitkan: | Elsevier 2023-11-01 |
Deskripsi
Summary: Despite the similar clinical outcomes after renin-angiotensin system (RAS) inhibitor (RASi) continuation or withdrawal in COVID-19, the effects on angiotensin-converting enzyme 2 (ACE2) and RAS metabolites remain unclear. In a substudy of the randomized controlled Austrian Corona Virus Adaptive Clinical Trial (ACOVACT), patients with hypertension and COVID-19 were randomized 1:1 to either RASi continuation (n = 30) or switch to a non-RASi medication (n = 29). RAS metabolites were analyzed using a mixed linear regression model (n = 30). Time to a sustained clinical improvement was equal and ACE2 did not differ between the groups but increased over time in both. Overall ACE2 was higher with severe COVID-19. ACE-S and Ang II levels increased as expected with ACE inhibitor discontinuation. These data support the safety of RASi continuation in COVID-19, although RASi were frequently discontinued in our post hoc analysis. The study was not powered to draw definite conclusions on clinical outcomes using small sample sizes.