Renin-angiotensin System Inhibitor Discontinuation in COVID-19 Did Not Modify Systemic ACE2 in a Randomized Controlled Trial

Overview

Journal iScience

Publisher Cell Press

Date 2023 Oct 23

PMID 37867935

Authors

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

Affiliations

Soon will be listed here.

Abstract

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.

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