Since December 2019, a novel coronavirus called SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has caused an international outbreak of respiratory illness described as COVID-19. Individuals with a history of cardiovascular disease develop a more severe illness and have higher rates of death. Because of the potential interaction between RAS blockers and SARS-CoV-2 mechanism of infection, there are ongoing scientific discussions on whether they should be stopped or continued in patients with COVID-19. It is crucial to determine whether RAS blockers should be discontinued or not in patients with COVID-19.
Drug: 1: discontinuation of RAS blocker therapy
discontinuation of RAS blocker therapy
Other Name: discontinuation of RAS blocker therapy
Drug: 2: continuation of RAS blocker therapy
continuation of RAS blocker therapy
Other Name: continuation of RAS blocker therapy
Inclusion Criteria:
- Age ≥ 18 years old.
- Chronically treated with RAS blockers (ACE inhibitors or ARBs on the last prescription
prior to admission with a treatment duration ≥ 1 month).
- Diagnosis of COVID-19 confirmed by the presence of SARS-CoV-2 on any biological sample
with any detection method.
- Patients hospitalized in a non-intensive care unit.
- Pregnancy test at inclusion visit for women of childbearing potential.
- Women of childbearing potential must agree to use adequate contraception according to
recommendations related to contraception and pregnancy testing in clinical trials, by
Clinical Trial Facilitation Group (CTFG).
Exclusion Criteria:
- Shock requiring vasoactive agents.
- Acute respiratory distress syndrome requiring invasive mechanical ventilation.
- Circulatory assistance.
- History of malignant hypertension according to the definition of the 2018 ESC/ESH
guidelines on hypertension.
- Uncontrolled blood pressure despite the use of five antihypertensive drugs.
- History of nephrotic syndrome.
- History of hospitalization for hemorrhagic stroke in the past 3 months.
- RAS blockers therapy previously stopped > 48h.
- No affiliation to the French Health Care System "Sécurité Sociale".
- Inability to obtain informed consent.
Cardiologie, Groupe Hospitalier Pitié-Salpêtrière
Paris, France
Gilles MONTALESCOT, MD, PhD, Principal Investigator
Institut Cardiologie - Pitié Salpêtrière(APHP) / ACTION Study Group / Univ. Paris 6 (UPMC) - INSERM UMRS 1166