RAS-COVID. Suspension or Maintenance of Renin-Angiotensin System Inhibitors in COVID-19-Infected Patients: RAS-COVID Randomized and Controlled Proof of Concept study

The relationship between the use of inhibitors of the renin-angiotensin system (RAS) and infection by the new coronavirus (COVID-19) is doubtful. Theoretically, the inhibition of the RAS increases the serum and tissue level of the angiotensin-converting enzyme type II (ACE2), which serves as a receptor for the virus to enter the cell. Thus, the use of medications that inhibit the RAS could increase the susceptibility and severity of the infection. Hypothesis: The discontinuation of RAS inhibitors in individuals infected with COVID-19 is associated with a reduction in the clinical severity of infection when compared to individuals who continued the antihypertensive medication during hospitalization. Goal: To investigate the impact of discontinuation of RAS inhibitors in patients admitted to the ward due to the new coronavirus on the combined outcome composed of the need for admission to the Intensive Care Unit or death from all causes. Methods: 220 patients with infection confirmed by COVID-19 will be randomized to maintenance of RAS inhibitors or suspension of these medications, which will be replaced by another pharmacological class if necessary. They will be monitored during hospitalization to assess outcomes until death or hospital discharge. Implications. In view of the current pandemic caused by COVID-19, this study helps the clinical practice of hospitalized patients and generates hypotheses for population strategies, especially in groups at risk for severe infection.