Improving outcomes in individuals with COVID-19 with renin-angiotensin system inhibition: the COVID-RASi trial
Cardiovascular disease is among the leading causes of death associated with COVID-19. Elderly patients with a history of heart attack, stroke, hypertension, or diabetes have a significantly higher chance of dying compared to other infected patients. A clinical trial will be launched amongst COVID-19 patients aged 65 and older with at least one of three pre-existing conditions (cardiovascular disease, diabetes, and obesity) to evaluate whether the use of a group of common blood pressure drugs called renin-angiotensin system inhibitors (RASi) may protect high-risk COVID-19 patients.
Preliminary evidence indicates that these drugs can be protective in high-risk patients. However, the data looked backwards at past events, which can be fraught with hidden biases. A rigorous, forward-looking trial to evaluate these agents in COVID-19 is thus required. A network of Canadian and international research institutes will evaluate whether adding RASi drugs, compared to no added treatment in high-risk COVID-19 patients, can decrease the chance of dying or requiring ventilators or intensive care units. If results confirm its benefit, using these common and inexpensive medications will potentially save many lives around the world.
The project was selected for funding through the COVID-19 May 2020 Rapid Research Funding Opportunity, coordinated by the Canadian Institutes of Health Research in partnership with IDRC and several other health research funding agencies across Canada.
Evaluation of the potential benefit of renin-angiotensin system inhibitors (RASi, ACEi/ARB) in high-risk patients with COVID-19 : the COVID-RASi trial
The COVID-19 pandemic has impacted the health and economy of countries around the world, bringing a major challenge for physicians and healthcare systems, due to the lack of evidence-based therapy. Patients admitted with COVID had a higher risk for worsening conditions requiring ICU, ventilation, or dialysis, and high mortality. At the peak of the pandemic, many patients with COVID-19 infections were older, with pre-existing cardiovascular (CV) conditions (e.g., prior heart attack, stroke, peripheral arterial disease), or had risk factors such as hypertension, obesity, diabetes, or chronic kidney disease. The scientific and clinical implications showed these patients had higher mortality, confirming the major interactions with the cardiovascular system. While the role of renin-angiotensin system inhibitors (RASi) was known to be protective of the cardiovascular system, and the evidence also showed that the SARS-CoV-2 virus uses the Angiotensin-Converting Enzyme 2 (ACE2) receptors, more research was needed to find evidence-based answers to show if RASi medications are protective for patients with COVID-19.
Author(s): Liu, Peter