Effect of Angiotensin-Converting Enzyme Inhibitor and Angiotensin Receptor Blocker Initiation on Organ Support-Free Days in Patients Hospitalized With COVID-19: A Randomized Clinical Trial
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View abstract on PubMed
Summary
This summary is machine-generated.Initiating angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in critically ill COVID-19 patients did not improve outcomes and may have worsened them. This study highlights potential risks associated with RAS inhibitors in this population.
Area Of Science
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background
- The renin-angiotensin system (RAS) plays a role in cardiovascular and renal function.
- Overactivation of the RAS has been implicated in severe COVID-19 outcomes.
- Understanding the impact of RAS inhibitors on COVID-19 patients is crucial for clinical management.
Purpose Of The Study
- To investigate whether initiating angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) improves clinical outcomes in hospitalized COVID-19 patients.
- To evaluate the safety and efficacy of RAS inhibitors in critically ill COVID-19 patients.
Main Methods
- An adaptive platform randomized clinical trial involving critically ill and non-critically ill hospitalized adults with COVID-19.
- Patients were randomized to receive ACE inhibitors, ARBs, or no RAS inhibitor (control) for up to 10 days.
- The primary outcome was organ support-free days, assessed using a Bayesian cumulative logistic model.
Main Results
- Enrollment was discontinued due to safety concerns.
- Initiation of ACE inhibitors or ARBs did not improve organ support-free days compared to control.
- RAS inhibitor initiation was associated with a higher probability of worsened clinical outcomes and lower hospital survival rates.
Conclusions
- In critically ill adults with COVID-19, initiating ACE inhibitors or ARBs did not improve clinical outcomes.
- RAS inhibitor use in this patient group likely worsened outcomes, including hospital survival.
- These findings suggest caution when using RAS inhibitors in critically ill COVID-19 patients.
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