Continuing ACE inhibitors and ARBs safe for patients with COVID-19

Researchers have concluded that it is safe for patients hospitalised with COVID-19 to continue taking their angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.
Doctor with COVID patient

Open access article

The Royal Pharmaceutical Society has made this article free to access in order to help healthcare professionals stay informed about an issue of national importance.

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Continuing angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) does not affect clinical outcomes for patients admitted to hospital with COVID-19, a randomised controlled trial published in Lancet Respiratory Medicine has found (7 January 2021)​[1]​.  

Between 31 March 2020 and 20 August 2020, the team enrolled 152 patients who were taking ACE inhibitors or ARBs prior to admission to hospital with COVID-19, and randomly assigned them to either temporarily stop or continue taking their medicines.  

The researchers then ranked each participant based on four factors, including days to death during hospitalisation, days supported by mechanical ventilation, days on renal replacement therapy and multi-organ dysfunction. 

They found that, compared with discontinuation, continuation of ACE inhibitor/ARB therapy did not affect the score. Patients also spent a similar length of time in hospital or intensive care regardless of whether they discontinued their prescribed medicines or not.  

“At the start of the pandemic, patients were worried about perceived harm based on limited and incomplete information and, unfortunately, some insisted on stopping their medications,” said Jordana Cohen, a nephrologist and clinical researcher at the University of Pennsylvania, Philadelphia, United States. 

Julio Chirinos, a cardiologist at the university and senior author of the study, added: “The results of this study indicate that it is safe for patients hospitalised with COVID-19 to continue these medications when required for other indications.” 

  1. 1
    Cohen JB, Hanff TC, William P, et al. Continuation versus discontinuation of renin–angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial. The Lancet Respiratory Medicine Published Online First: January 2021. doi:10.1016/s2213-2600(20)30558-0
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Citation
The Pharmaceutical Journal, March 2021;Online:DOI:10.1211/PJ.2021.1.48788