iScience (Nov 2023)
Renin-angiotensin system inhibitor discontinuation in COVID-19 did not modify systemic ACE2 in a randomized controlled trial
- Vincent Rathkolb,
- Marianna T. Traugott,
- Andreas Heinzel,
- Marko Poglitsch,
- Judith Aberle,
- Farsad Eskandary,
- Agnes Abrahamowicz,
- Martin Mueller,
- Petra Knollmueller,
- Tarik Shoumariyeh,
- Jasmin Stuflesser,
- Ivan Seeber,
- Georg Gibas,
- Hannah Mayfurth,
- Viktoria Tinhof,
- Lukas Schmoelz,
- Markus Zeitlinger,
- Christian Schoergenhofer,
- Bernd Jilma,
- Bernd Genser,
- Wolfgang Hoepler,
- Sara Omid,
- Mario Karolyi,
- Christoph Wenisch,
- Rainer Oberbauer,
- Alexander Zoufaly,
- Manfred Hecking,
- Roman Reindl-Schwaighofer
Affiliations
- Vincent Rathkolb
- Department of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, Austria
- Marianna T. Traugott
- Department of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
- Andreas Heinzel
- Department of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, Austria
- Marko Poglitsch
- Attoquant Diagnostics, Vienna, Austria
- Judith Aberle
- Institute of Virology, Medical University of Vienna, Wien, Austria
- Farsad Eskandary
- Department of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, Austria
- Agnes Abrahamowicz
- Department of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, Austria
- Martin Mueller
- Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria
- Petra Knollmueller
- Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria
- Tarik Shoumariyeh
- Department of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, Austria
- Jasmin Stuflesser
- Department of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
- Ivan Seeber
- Department of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
- Georg Gibas
- Department of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
- Hannah Mayfurth
- Department of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, Austria
- Viktoria Tinhof
- Department of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, Austria
- Lukas Schmoelz
- Department of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, Austria
- Markus Zeitlinger
- Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria
- Christian Schoergenhofer
- Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria
- Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Wien, Austria
- Bernd Genser
- Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Wolfgang Hoepler
- Department of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
- Sara Omid
- Department of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
- Mario Karolyi
- Department of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
- Christoph Wenisch
- Department of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria
- Rainer Oberbauer
- Department of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, Austria
- Alexander Zoufaly
- Department of Internal Medicine IV with Infectious Diseases and Tropical Medicine, Clinic Favoriten, Vienna, Austria; Faculty of Medicine, Sigmund Freud University, Vienna, Austria
- Manfred Hecking
- Department of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, Austria; Corresponding author
- Roman Reindl-Schwaighofer
- Department of Internal Medicine III, Clinical Division of Nephrology & Dialysis, Medical University of Vienna, Wien, Austria
- Journal volume & issue
-
Vol. 26,
no. 11
p. 108146
Abstract
Summary: Despite the similar clinical outcomes after renin-angiotensin system (RAS) inhibitor (RASi) continuation or withdrawal in COVID-19, the effects on angiotensin-converting enzyme 2 (ACE2) and RAS metabolites remain unclear. In a substudy of the randomized controlled Austrian Corona Virus Adaptive Clinical Trial (ACOVACT), patients with hypertension and COVID-19 were randomized 1:1 to either RASi continuation (n = 30) or switch to a non-RASi medication (n = 29). RAS metabolites were analyzed using a mixed linear regression model (n = 30). Time to a sustained clinical improvement was equal and ACE2 did not differ between the groups but increased over time in both. Overall ACE2 was higher with severe COVID-19. ACE-S and Ang II levels increased as expected with ACE inhibitor discontinuation. These data support the safety of RASi continuation in COVID-19, although RASi were frequently discontinued in our post hoc analysis. The study was not powered to draw definite conclusions on clinical outcomes using small sample sizes.
