ACEI-COVID-19 is a multicenter, randomized trial testing the hypothesis that stopping/replacing chronic treatment with ACE-inhibitors (ACEI) or angiotensin receptor blockers (ARB) improves outcomes in symptomatic SARS-CoV2-infected patients
The COVID-19 pandemic currently poses unprecedented challenges to the health systems of all
countries. Experimental studies show that the SARS-CoV2 virus enters human cells via the
angiotensin converting enzyme II receptor 2 (ACE2). ACE inhibitors (ACEI) and angiotensin
receptor blockers (ARB) can lead to an increase in the expression of ACE2. Therefore, there
is concern that in patients treated with ACEI or ARB, the absorption of the virus is
facilitated, thereby accelerating its spread in the body.
ACEI-COVID tests the hypothesis that stopping chronic ACEI / ARB therapy in
SARS-CoV2-infected patients improves outcomes.
Drug: ACE inhibitor, angiotensin receptor blocker
In patients randomized to stopping / replacing ACEI or ARB, it may be necessary to switch to another drug without direct effect on the RAS system. In patients, randomized to continuation, it may be needed to stop ACEI or ARB (e.g. hypotension with beginning sepsis) irrespective of the study.
Inclusion Criteria:
- Female and male patients competent to make a decision
- Proven and symptomatic SARS-CoV2 infection ≤ 5 days
- Patient age ≥ 18 years
- Provided written informed consent
- Chronic (≥ 1 month) ACEI/ARB therapy for treatment of arterial hypertension, diabetes
mellitus, heart failure or coronary artery disease
- Stable hemodynamic conditions allowing to stop or continue treatment with ACEI/ARB
(systolic blood pressure ≤180mmHg)
Exclusion Criteria:
- Women capable of bearing children as well as pregnant and breastfeeding women
- Participant in another interventional trail
- At screening visit, no oral medication intake possible
- Advanced heart failure NYHA Stage III-IV
- Left ventricular ejection fraction <30% or NTproBNP ≥600pg/mL in case of clinical
signs of heart failure
- Acute coronary syndrome ≤ 3 months
- Severe arterial hypertension (concomitant use of more than 4 different
antihypertensive drug classes)
- Acute respiratory distress syndrome with need for mechanical ventilation
- Patients who at not capable of home blood pressure monitoring
- Patients who cannot be switched to an alternative medication
Medical University Innsbruck, University Hospital of Internal Medicine III
Innsbruck, Tyrol, Austria
Medical University of Graz
Graz, Austria
Landeskrankenhaus Hall
Hall In Tirol, Austria
Medical University Innsbruck, Intensive Care and Emergency Medicine Department
Innsbruck, Austria
Medical University Innsbruck, University Hospital of Internal Medicine II
Innsbruck, Austria
Medical University Innsbruck, University Hospital of Internal Medicine IV
Innsbruck, Austria
Medical University Innsbruck, University Hospital of Internal Medicine I
Innsbruck, Austria
Medical University Innsbruck, University Hospital of Internal Medicine V
Innsbruck, Austria
Klinikum Klagenfurt
Klagenfurt, Austria
Bezirkskrankenhaus Kufstein
Kufstein, Austria
Klinikum Lienz
Lienz, Austria
Bezirkskrankenhaus St. Johann
Sankt Johann In Tirol, Austria
Bezirkskrankenhaus Schwaz
Schwaz, Austria
Krankenhaus St. Vinzenz Zams
Zams, Austria
LMU Klinikum, Medizinische Klinik I
Munich, Bavaria, Germany
University Hospital Aachen
Aachen, Germany
University Hospital Augsburg
Augsburg, Germany
Asklepios Stadtklinik Bad Tölz
Bad Tölz, Germany
Klinikum Dachau
Dachau, Germany
University Hospital Erlangen
Erlangen, Germany
University Hospital Essen
Essen, Germany
University of Freiburg
Freiburg, Germany
Klinikum Memmingen
Memmingen, Germany
LMU Klinikum, Medizinische Klinik III
Munich, Germany
LMU Klinikum, Medizinische Klinik II
Munich, Germany
LMU Klinikum, Medizinische Klinik IV
Munich, Germany
München Klinik Bogenhausen und Schwabing
Munich, Germany
Rotkreuzklinikum Munich
Munich, Germany
Krankenhaus Mühldorf
Mühldorf, Germany
Klinikum Rosenheim
Rosenheim, Germany
Krankenhaus Weiden
Weiden, Germany