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Coronavirus (COVID-19) ACEi/ARB Investigation (CORONACION)

Primary Purpose

Hypertension, COVID-19

Status
Suspended
Phase
Phase 4
Locations
Ireland
Study Type
Interventional
Intervention
Thiazide or Thiazide-like diuretics
Calcium Channel Blockers
ACE inhibitor
Angiotensin receptor blocker
Sponsored by
National University of Ireland, Galway, Ireland
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Hypertension focused on measuring Hypertension, Blood Pressure, COVID-19, Coronavirus Disease 2019, Novel Coronavirus, Coronavirus, Cardiovascular Diseases, Pandemic, Critical Care, Intubation, Noninvasive Ventilation, Angiotensin Converting Enzyme, Angiotensin Converting Enzyme 2, Renin-Angiotensin System, Antihypertensive Agents, Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Antagonists, Calcium Channel Blockers, Diuretics, ACE-2

Eligibility Criteria

60 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Men and non-pregnant women aged 60 or over
  • Known diagnosis of hypertension
  • Current use of ACEi or ARB for the treatment of hypertension
  • COVID-19 naïve (i.e. not known to be infected)
  • English speaker

Exclusion Criteria:

  • Known diabetic nephropathy
  • Known heart failure with reduced ejection fraction
  • Resistant hypertension (defined as blood pressure that remains above goal despite concurrent use of three anti-hypertensive agents of different classes, one of which should be a diuretic, or as blood pressure that is controlled with four or more medications)
  • Contraindications or allergies to CCB or Thiazide
  • Unconscious patients
  • Current psychiatric in-patients
  • Patients in an emergency medical setting
  • Inability to consent

Sites / Locations

  • University Hospital Galway

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Alternative anti-hypertensive medication

Continue ACEi/ARB antihypertensive

Arm Description

Switch to an alternative BP medication (specifically a Calcium channel blocker [CCB] or Thiazide/Thiazide-like diuretic at an equipotent blood pressure lowering dose). The choice of either CCB or Thiazide/Thiazide-like anti-hypertensive provided as alternative therapy will be at the discretion of the patient's treating physician.

Continue with either the ACEi (Angiotensin Converting Enzyme Inhibitor) or the Angiotensin Receptor Blocker (ARB) that had already been prescribed for the treatment of hypertension.

Outcomes

Primary Outcome Measures

Number of Covid-19 positive participants who die, require intubation in ICU, or require hospitalization for non-invasive ventilation (NIV)
Time from randomization to the first occurrence of any of the clinical events above

Secondary Outcome Measures

Number of Covid-19 positive participants who die
Time from randomization to the first occurrence of above
Number of Covid-19 positive participants who require intubation in intensive care unit (ICU)
Time from randomization to the first occurrence of above
Number of Covid-19 positive participants who require hospitalization for non-invasive ventilation (NIV)
Time from randomization to the first occurrence of above
Number of SARS-CoV-2 positive participants
Time from randomization to the first occurrence of above
Maximum troponin T value (ng/L) among Covid-19 positive participants who require acute hospitalization
24 hour mean systolic BP (mmHg) on ambulatory BP monitoring
Performed in a random sub-sample of the cohort (both study arms)
All-cause mortality
Time from randomization to the first occurrence of above

Full Information

First Posted
March 30, 2020
Last Updated
June 26, 2020
Sponsor
National University of Ireland, Galway, Ireland
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1. Study Identification

Unique Protocol Identification Number
NCT04330300
Brief Title
Coronavirus (COVID-19) ACEi/ARB Investigation
Acronym
CORONACION
Official Title
The CORONAvirus Disease 2019 Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker InvestigatiON (CORONACION) Randomized Clinical Trial
Study Type
Interventional

2. Study Status

Record Verification Date
June 2020
Overall Recruitment Status
Suspended
Why Stopped
Challenges with funding and very low incidence of COVID-19 at Irish study site
Study Start Date
April 30, 2020 (Actual)
Primary Completion Date
July 31, 2021 (Anticipated)
Study Completion Date
December 1, 2021 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
National University of Ireland, Galway, Ireland

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Coronavirus disease 2019 (COVID-19) is a pandemic infection caused by a virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Because SARS-CoV-2 is known to require the angiotensin-converting enzyme 2 (ACE-2) receptor for uptake into the human body, there have been questions about whether medications that upregulate ACE-2 receptors might increase the risk of infection and subsequent complications. One such group of medications are anti-hypertensives that block the renin-angiotensin system, including both angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB). Both ACEi and ARB are widely used for the treatment of hypertension. Early reports from China and Italy suggest that many of those who die from COVID-19 have a coexisting history of hypertension. Consequently, there have been questions raised as to whether these 2 types of blood pressure medication might increase the risk of death among patients with COVID-19. However, it is well known that the prevalence of hypertension increases linearly with age. Therefore, it is possible that the high prevalence of hypertension and ACEi/ARB use among persons who die from COVID-19 is simply confounded by age (older people are at risk of both a history of hypertension and dying from COVID-19). Whether these commonly prescribed blood pressure medications increase the risk of COVID-19 or not remains unanswered. Statements from professional cardiology societies on both sides of the Atlantic have called for urgent research into this question. Our study aims to randomize patients with primary (essential) hypertension who are already taking ACEi/ARB to either switch to an alternative BP medication or continue with the ACEi/ARB that they have already been prescribed. Adults with compelling indications for ACEi/ARB will not be enrolled.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hypertension, COVID-19
Keywords
Hypertension, Blood Pressure, COVID-19, Coronavirus Disease 2019, Novel Coronavirus, Coronavirus, Cardiovascular Diseases, Pandemic, Critical Care, Intubation, Noninvasive Ventilation, Angiotensin Converting Enzyme, Angiotensin Converting Enzyme 2, Renin-Angiotensin System, Antihypertensive Agents, Angiotensin-Converting Enzyme Inhibitors, Angiotensin Receptor Antagonists, Calcium Channel Blockers, Diuretics, ACE-2

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
2414 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Alternative anti-hypertensive medication
Arm Type
Experimental
Arm Description
Switch to an alternative BP medication (specifically a Calcium channel blocker [CCB] or Thiazide/Thiazide-like diuretic at an equipotent blood pressure lowering dose). The choice of either CCB or Thiazide/Thiazide-like anti-hypertensive provided as alternative therapy will be at the discretion of the patient's treating physician.
Arm Title
Continue ACEi/ARB antihypertensive
Arm Type
Active Comparator
Arm Description
Continue with either the ACEi (Angiotensin Converting Enzyme Inhibitor) or the Angiotensin Receptor Blocker (ARB) that had already been prescribed for the treatment of hypertension.
Intervention Type
Drug
Intervention Name(s)
Thiazide or Thiazide-like diuretics
Other Intervention Name(s)
Hydrochlorothiazide, metolazone, chlorthalidone, chlorothiazide, bendroflumethiazide, indapamide
Intervention Description
Anti-hypertensive (Active Arm)
Intervention Type
Drug
Intervention Name(s)
Calcium Channel Blockers
Other Intervention Name(s)
Amlodipine, diltiazem, felodipine, nicardipine, nifedipine, nimodipine, nitrendipine, verapamil
Intervention Description
Anti-hypertensive (Active Arm)
Intervention Type
Drug
Intervention Name(s)
ACE inhibitor
Other Intervention Name(s)
Benazepril, captopril, enalapril, fosinopril, lisinopril, perindopril, quinapril, ramipril, trandolapril
Intervention Description
Anti-hypertensive (Control Arm)
Intervention Type
Drug
Intervention Name(s)
Angiotensin receptor blocker
Other Intervention Name(s)
Candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan
Intervention Description
Anti-hypertensive (Control Arm)
Primary Outcome Measure Information:
Title
Number of Covid-19 positive participants who die, require intubation in ICU, or require hospitalization for non-invasive ventilation (NIV)
Description
Time from randomization to the first occurrence of any of the clinical events above
Time Frame
12 months
Secondary Outcome Measure Information:
Title
Number of Covid-19 positive participants who die
Description
Time from randomization to the first occurrence of above
Time Frame
12 months
Title
Number of Covid-19 positive participants who require intubation in intensive care unit (ICU)
Description
Time from randomization to the first occurrence of above
Time Frame
12 months
Title
Number of Covid-19 positive participants who require hospitalization for non-invasive ventilation (NIV)
Description
Time from randomization to the first occurrence of above
Time Frame
12 months
Title
Number of SARS-CoV-2 positive participants
Description
Time from randomization to the first occurrence of above
Time Frame
12 months
Title
Maximum troponin T value (ng/L) among Covid-19 positive participants who require acute hospitalization
Time Frame
12 months
Title
24 hour mean systolic BP (mmHg) on ambulatory BP monitoring
Description
Performed in a random sub-sample of the cohort (both study arms)
Time Frame
12 months
Title
All-cause mortality
Description
Time from randomization to the first occurrence of above
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
60 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Men and non-pregnant women aged 60 or over Known diagnosis of hypertension Current use of ACEi or ARB for the treatment of hypertension COVID-19 naïve (i.e. not known to be infected) English speaker Exclusion Criteria: Known diabetic nephropathy Known heart failure with reduced ejection fraction Resistant hypertension (defined as blood pressure that remains above goal despite concurrent use of three anti-hypertensive agents of different classes, one of which should be a diuretic, or as blood pressure that is controlled with four or more medications) Contraindications or allergies to CCB or Thiazide Unconscious patients Current psychiatric in-patients Patients in an emergency medical setting Inability to consent
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
John William McEvoy, MBBCh MHS
Organizational Affiliation
National University of Ireland, Galway, Ireland
Official's Role
Principal Investigator
Facility Information:
Facility Name
University Hospital Galway
City
Galway
ZIP/Postal Code
H91 YR71
Country
Ireland

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Time Frame
12-24 months
IPD Sharing Access Criteria
To be determined

Learn more about this trial

Coronavirus (COVID-19) ACEi/ARB Investigation

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