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Lancet Study Finds Commonly Used Blood Pressure Medications Safe for COVID-19 Patients

Medications to treat high blood pressure do not affect outcomes of patients hospitalized with COVID-19, according to heart and hypertension experts with the University of Miami Miller School of Medicine, who took part in a recent international study. Investigators examined whether ACE inhibitors (ACEIs) or Angiotensin Receptor Blockers (ARBs) – two classes of medications to treat high blood pressure – could help mitigate complications or lead to more severe symptoms.

“This was a randomized controlled trial and the strongest evidence to prove that these heart medications are safe,” said Carlos E. Alfonso, M.D., an interventional cardiologist and associate professor of medicine with the Miller School and director of the cardiology fellowship training program at UM/Jackson Memorial Hospital.

The REPLACE COVID trial was led by two principal investigators at the University of Pennsylvania, Jordana Cohen, M.D., and Julio Chirinos M.D., a graduate of the UM/JMH cardiology fellowship program.  Dr. Alfonso was a coauthor of the study, “Continuation Versus Discontinuation of Renin–Angiotensin System Inhibitors in Patients Admitted to Hospital with COVID-19: A Prospective, Randomised, Open-Label Trial,” published recently in The Lancet.

In the REPLACE COVID trial, UM physician-researchers enrolled patients from UHealth Tower, the flagship hospital of the University of Miami Health System. They were treated by Dr. Alfonso, cardiologist Adedapo Iluyomade, M.D., and Maria Carolina Delgado-Lelievre, M.D., assistant professor of medicine and director of the University of Miami Comprehensive Hypertension Center.

“More than 50 percent of adults in the U.S. have hypertension, the Number One risk for heart disease,” said Dr. Delgado-Lelievre. “So it was very important to establish that these medications do not change an individual’s risk for COVID.”

She added that medications to control blood pressure also have a protective effect on the heart muscle, kidneys and overall vascular system. “Our team at the Comprehensive Hypertension Center focuses on providing patients with precision treatments based on genetics, biochemical profile, physiology and other factors,” she said. “We also educate our patients and family members about diet and lifestyle changes to prevent hypertension or reduce negative impacts.”

Experts with the UHealth Cardiovascular Division are renowned national leaders in COVID-19 research. At UHealth’s COVID-19 Heart Program, the team has been innovative in treating and diagnosing cardiac issues related to COVID-19 patients and researching the virus’ impact on the heart.

Dr. Alfonso said that early in the pandemic, it was believed that ACEIs or ARBs might put hypertension patients at greater risk for adverse COVID-19 outcomes because of the way the virus attaches to certain cellular receptors. “There were concerns that these patients should halt taking the drugs, although it was also possible that these medications might be protective against the virus.”

In the REPLACE COVID trial, investigators enrolled 152 participants across several countries between March 31 and August 20, 2020, who were hospitalized with COVID-19 and already using one of the medications. The participants were randomly assigned to either stop or continue taking their prescribed medication, and they were closely monitored to evaluate the effect of temporarily stopping the therapy.

Through analyzing the patient outcome data, the team found discontinuation of ACEIs and ARBs compared with continuation of these medications had no effect on outcomes.

“It is safe to conclude that ACEIs and ARBs are safe to use during the pandemic, as they do not cause any adverse or greater impact of the virus,” said Dr. Alfonso. He added that the results are in agreement with the larger-scale BRACE CORONA study in Brazil, whose findings were presented at the European Society of Cardiology meeting and are pending publication.

Tags: Angiotensin Receptor Blockers, Dr. Carlos Alfonso, Dr. Maria Carolina Delgado-Lelievre, REPLACE COVID trial