At the beginning of the pandemic, cardiologists and cardiovascular patients were uncertain: could drugs from the group of ACE inhibitors and angiotensin receptor blockers be to blame for the fact that so many cardiovascular patients suffered a severe course of COVID-19? The drugs interfere with the renin-angiotensin system and upregulate the ACE2 receptor, which serves as a gateway for the coronavirus - more receptor, more virus was the hypothesis. ACE inhibitors and angiotensin receptor blockers are among the most widely prescribed drugs worldwide and are used to treat arterial hypertension, heart failure and diabetes mellitus, among other conditions.

Stopping the medication had no effect on the maximum severity of the disease. However, there were indications that patients who took a break recovered faster and better. After 30 days, only half as many patients in the group that paused treatment had organ damage or had died compared to the group that continued treatment. "In contrast to previous studies, which included significantly younger patients, our study provides evidence for the first time that older, previously ill people in particular could benefit from temporarily pausing therapy with ACE inhibitors or angiotensin receptor blockers," say Axel Bauer and Steffen Massberg.

However, the authors warn against generalizing the findings: "In individual cases, it may make sense to temporarily suspend therapy in the context of an acute COVID-19 disease. However, the decision must be made by a doctor. It is important to carefully consider the indication for the medication, the availability of alternative therapies and outpatient monitoring options. In any case, it is important to start taking the important medication again once the illness has been overcome."

University Hospitals Innsbruck and Institutes of the Medical University Innsbruck, Clinics and Institutes of the LMU Clinic Munich, State Hospital Hall, Hospital Schwaz, Red Cross Clinic Munich, Hospital Memmingen, Hospital Zams, Hospital Augsburg, University Duisburg-Essen, University Freiburg, German Center for Cardiovascular Research, Hospital Mühldorf, Hospital St. Johann in Tirol, Hospital Weiden, Hospital Dachau, Clinic Klagenfurt, Munich Clinic Bogenhausen & Schwabing, University Hospital Aachen, University Hospital Erlangen.

Discontinuation versus continuation of renin-angiotensin system inhibitors in COVID-19 (ACEI-COVID): a prospective, parallel group, randomized, controlled, open-label trial

Axel Bauer, Michael Schreinlechner, Nikolay Vdovin, Theresa Dolejsi, Herbert Tilg, Benedikt A Aulinger, Günter Weiss, Rosa Bellmann-Weiler, Christian Adolf, Dominik Wolf, Markus Pirklbauer, Ivo Graziadei, Hannes Gänzer, Christian von Bary, Andreas E May, Ewald Wöll, Wolfgang von Scheidt, Tienush Rassaf, Daniel Duerschmied, Christoph Brenner, Stefan Kääb, Bernhard Metzler, Michael Joannidis, Hans-Ulrich Kain, Norbert Kaiser, Robert Schwinger, Bernhard Witzenbichler, Hannes Alber, Florian Straube, Niels Hartmann, Stephan Achenbach, Michael von Bergwelt-Baildon, Lukas von Stulpnagel, Sebastian Schoenherr, Lukas Forer, Sabine Embacher-Aichhorn, Ulrich Mansmann, Konstantinos D Rizas, Steffen Massberg for the ACEICOVID investigators

The Lancet Respiratory Medicine: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00214-9/fulltext