Portal de investigação
A randomized controlled trial of renin-angiotensin-aldosterone system inhibitor management in patients admitted in hospital with COVID-19
Data de publicação:
Data Ahead of Print:
Autores da FMUP
Participantes de fora da FMUP
- Sharma, A
- Elharram, M
- Afilalo, J
- Flannery, A
- Afilalo, M
- Tselios, C
- Ni, JY
- Ezekowitz, JA
- Cheng, MP
- Ambrosy, AP
- Zannad, F
- Brophy, JM
- Giannetti, N
- Bessissow, A
- Kronfli, N
- Marelli, A
- Aziz, H
- Alqahtani, M
- Aflaki, M
- Craig, M
- Lopes, RD
Unidades de investigação
Abstract
Background Renin-angiotensin aldosterone system inhibitors (RAASi) are commonly used among patients hospitalized with a severe acute respiratory syndrome coronavirus 2 infection coronavirus disease 2019 (COVID-19). We evaluated whether continuation versus discontinuation of RAASi were associated with short term clinical or biochemical outcomes. Methods The RAAS-COVID-19 trial was a randomized, open label study in adult patients previously treated with RAASi who are hospitalized with COVID-19 (NCT04508985). Participants were randomized 1:1 to discontinue or continue RAASi. The primary outcome was a global rank score calculated from baseline to day 7 (or discharge) incorporating clinical events and biomarker changes. Global rank scores were compared between groups using the Wilcoxon test statistic and the negative binomial test (using incident rate ratio [IRR]) and the intention-to-treat principle. Results Overall, 46 participants were enrolled; 21 participants were randomized to discontinue RAASi and 25 to continue. Patients' mean age was 71.5 years and 43.5% were female. Discontinuation of RAASi, versus continuation, resulted in a non-statistically different mean global rank score (discontinuation 6 [standard deviation [SD] 6.3] vs continuation 3.8 (SD 2.5); P = .60). The negative binomial analysis identified that discontinuation increased the risk of adverse outcomes (IRR 1.67 [95% CI 1.06-2.62]; P = .027); RAASi discontinuation increased brain natriuretic peptide levels (% change from baseline: + 16.7% vs-27.5%; P = .024) and the incidence of acute heart failure (33% vs 4.2%, P = .016). Conclusion RAASi continuation in participants hospitalized with COVID-19 appears safe; discontinuation increased brain natriuretic peptide levels and may increase risk of acute heart failure; where possible, RAASi should be continued.
Dados da publicação
- ISSN/ISSNe:
- 1097-6744, 0002-8703
- Tipo:
- Article
- Páginas:
- 76-89
- Link para outro recurso:
- www.scopus.com
American Heart Journal Mosby Inc.
Citações Recebidas na Web of Science: 11
Citações Recebidas na Scopus: 13
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Filiações
Keywords
- Adult; Aged; Aldosterone; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; COVID-19; Female; Heart Failure; Hospitals; Humans; Natriuretic Peptide, Brain; Renin-Angiotensin System; acetylsalicylic acid; angiotensin receptor antagonist; anti-SARS-CoV-2 agent; anticoagulant agent; antihypertensive agent; antineoplastic agent; beta adrenergic receptor blocking agent; biological marker; brain natriuretic peptide; C reactive protein; calcium channel blocking agent; dexamethasone; dipeptidyl carboxypeptidase inhibitor; glucose; hemoglobin; hydroxymethylglutaryl coenzyme A reductase inhibitor; mineralocorticoid antagonist; nonsteroid antiinflammatory agent; potassium; sodium; troponin; troponin I; warfarin; aldosterone; angiotensin receptor antagonist; antihypertensive agent; brain natriuretic peptide; dipeptidyl carboxypeptidase inhibitor; acute heart failure; acute heart infarction; acute kidney failure; adverse drug reaction; African Amer
Financiamento
Proyectos asociados
Dapagliflozin, Spironolactone or Both for HFpEF (SOGALDI-PEF) - NCT05676684
Investigador Principal: João Pedro Melo Marques Pinho Ferreira
Ensaio Clínico Académico (SOGALDI-PEF) . AstraZeneca . 2022
Citar a publicação
Sharma A,Elharram M,Afilalo J,Flannery A,Afilalo M,Tselios C,Ni JY,Ezekowitz JA,Cheng MP,Ambrosy AP,Zannad F,Brophy JM,Giannetti N,Bessissow A,Kronfli N,Marelli A,Aziz H,Alqahtani M,Aflaki M,Craig M,Lopes RD,Ferreira JP. A randomized controlled trial of renin-angiotensin-aldosterone system inhibitor management in patients admitted in hospital with COVID-19. Am. Heart J. 2022. 247. p. 76-89. IF:4,800. (2).
