Study: Blood Pressure Medications Safe for Patients With COVID-19

A recent study led by University of Pennsylvania researchers reported no risk for patients continuing their blood pressure medications while hospitalized with coronavirus disease 2019 (COVID-19).¹

The study, which was published in The Lancet Respiratory Medicine, compared COVID-19 patient outcomes among individuals with diabetes by either continuing or discontinuing renin-angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs).^1,2

Upwards of 49 million adults in the US take medication to treat hypertension, 83% of whom are treated with ACEIs or ARBs, according to study investigators. These 2 classes of high blood pressure medications are ubiquitous worldwide. With COVID-19 cases still surging in many places across the globe, researchers aimed to determine whether these medications affected outcomes in COVID-19 patients with hypertension and other comorbid conditions.

The prospective, randomized, open-label REPLACE COVID trial was held at 20 hospitals spanning 7 countries: United States, Canada, Mexico, Sweden, Peru, Bolivia, and Argentina. A total of 152 patients 18 years and older who had been admitted to the hospital with clinical presentation of COVID-19 and were prescribed either ACEI or ARB outpatient therapy prior to admission were included in the study.

Between March 31 and August 20, 2020, study participants were randomized to either stop (n=77) or continue (n=75) taking their ACEI or ARB medication. Patients were ranked against each other according to 4 hierarches of clinical outcomes:

1. time to death during hospitalization,
2. length of time on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO)
3. length of time on renal replacement therapy or inotropic or vasopressor therapy, and
4. area under the curve (AUC) of a modified SOFA score, incorporating the cardiac, respiratory, coagulation, and renal domains.¹

The mean age of patients was 62 years and 68 (45%) were female. Fifty-two percent had diabetes, 16% (24) had cardiac disease, and all participants showed a history of hypertension. ACEI therapy was slightly more common than ARB therapy among patients.

Investigators found that continuation of ACEI or ARB therapy among hospitalized COVID-19 patients had no overall effect on severity of infection and are consistent with previously published observational studies and unpublished trial evidence.

“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. However, stopping these medications unnecessarily can increase the risk for severe complications, including heart attack and stroke,” said first author Jordana B. Cohen, MD, MSCE, an assistant professor in the division of renal-electrolyte and hypertension, and a co-principal investigator with Chirinos. “Now we have high quality evidence to support our recommendation that patients continue to take these medications as prescribed.”

References

1. Cohen JB, Hanff TC, William P, et al. Continuation versus discontinuation of renin-angiotension system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomized, open-label trial. The Lancet; January 7, 2021. doi: https://doi.org/10.1016/S2213-2600(20)30558-0.
2. Study Finds Commonly Used Blood Pressure Medications Safe for COVID-19 Patients. News Release. Penn Medicine; January 7, 2021. Accessed January 19, 2021. https://www.pennmedicine.org/news/news-releases/2021/january/study-finds-commonly-used-blood-pressure-medications-safe-for-covid19-patients.