ACE Inhibitors or ARBs Discontinuation in Context of COVID-19 Pandemic

ACE Inhibitors or ARBs Discontinuation for Clinical Outcome Risk Reduction in Patients Hospitalized for the Endemic Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) Infection: the Randomized ACORES-2 Study

Since December 2019, a novel coronavirus called SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has caused an international outbreak of respiratory illness described as COVID-19.

Individuals with a history of cardiovascular disease develop a more severe illness and have higher rates of death.

Because of the potential interaction between RAS blockers and SARS-CoV-2 mechanism of infection, there are ongoing scientific discussions on whether they should be stopped or continued in patients with COVID-19.

It is crucial to determine whether RAS blockers should be discontinued or not in patients with COVID-19.

Inclusion Criteria:

• Age ≥ 18 years old.
• Chronically treated with RAS blockers (ACE inhibitors or ARBs on the last prescription prior to admission with a treatment duration ≥ 1 month).
• Diagnosis of COVID-19 confirmed by the presence of SARS-CoV-2 on any biological sample with any detection method.
• Patients hospitalized in a non-intensive care unit.
• Pregnancy test at inclusion visit for women of childbearing potential.
• Women of childbearing potential must agree to use adequate contraception according to recommendations related to contraception and pregnancy testing in clinical trials, by Clinical Trial Facilitation Group (CTFG).

Exclusion Criteria:

• Shock requiring vasoactive agents.
• Acute respiratory distress syndrome requiring invasive mechanical ventilation.
• Circulatory assistance.
• History of malignant hypertension according to the definition of the 2018 ESC/ESH guidelines on hypertension.
• Uncontrolled blood pressure despite the use of five antihypertensive drugs.
• History of nephrotic syndrome.
• History of hospitalization for hemorrhagic stroke in the past 3 months.
• RAS blockers therapy previously stopped > 48h.
• No affiliation to the French Health Care System "Sécurité Sociale".
• Inability to obtain informed consent.