Stopping ACE-inhibitors in COVID-19

Stopping ACE-inhibitors in COVID-19: A Randomized Controlled Trial

ACEI-COVID-19 is a multicenter, randomized trial testing the hypothesis that stopping/replacing chronic treatment with ACE-inhibitors (ACEI) or angiotensin receptor blockers (ARB) improves outcomes in symptomatic SARS-CoV2-infected patients

The COVID-19 pandemic currently poses unprecedented challenges to the health systems of all countries. Experimental studies show that the SARS-CoV2 virus enters human cells via the angiotensin converting enzyme II receptor 2 (ACE2). ACE inhibitors (ACEI) and angiotensin receptor blockers (ARB) can lead to an increase in the expression of ACE2. Therefore, there is concern that in patients treated with ACEI or ARB, the absorption of the virus is facilitated, thereby accelerating its spread in the body.

ACEI-COVID tests the hypothesis that stopping chronic ACEI / ARB therapy in SARS-CoV2-infected patients improves outcomes.

Inclusion Criteria:

• Female and male patients competent to make a decision
• Proven and symptomatic SARS-CoV2 infection ≤ 5 days
• Patient age ≥ 18 years
• Provided written informed consent
• Chronic (≥ 1 month) ACEI/ARB therapy for treatment of arterial hypertension, diabetes mellitus, heart failure or coronary artery disease
• Stable hemodynamic conditions allowing to stop or continue treatment with ACEI/ARB (systolic blood pressure ≤180mmHg)

Exclusion Criteria:

• Women capable of bearing children as well as pregnant and breastfeeding women
• Participant in another interventional trail
• At screening visit, no oral medication intake possible
• Advanced heart failure NYHA Stage III-IV
• Left ventricular ejection fraction <30% or NTproBNP ≥600pg/mL in case of clinical signs of heart failure
• Acute coronary syndrome ≤ 3 months
• Severe arterial hypertension (concomitant use of more than 4 different antihypertensive drug classes)
• Acute respiratory distress syndrome with need for mechanical ventilation
• Patients who at not capable of home blood pressure monitoring
• Patients who cannot be switched to an alternative medication