Intensive Therapy Reduces Risks for Patients With Acute Heart Failure

Not Effective Against COVID-19 A pragmatic randomized clinical trial demonstrated that angiotensin receptor blockers (ARBs), widely used as an antihypertensive and used to treat individuals with a high risk of heart disease, did not improve clinical outcomes among people hospitalized with COVID-19. Because SARS-CoV-2 enters host cells by binding to angiotensin-converting enzyme 2 (ACE-2) receptors, the investigators evaluated whether modulation of the reninangiotensin system with ARBs might reduce disease severity. The trial was conducted at 17 hospitals in Australia and India from May 2020 through November 2021. It included 787 patients whose average age was 49 years and who were naive to ARBs. The 778 participants in India were randomly assigned to receive 40 mg/d of telmisartan or to receive placebo for 28 days. In Australia, the ARB type and dose were at the discretion of the treating physician; the control group received only standard of care because the placebo was not available there during the early stage of the pandemic. The primary end point was COVID-19 disease severity using a modified World Health Organization (WHO) Clinical Progression Scale. After 14 days of treatment, there was no meaningful difference in illness severity between the 2 groups, so the trial was stopped for futility. The trial cohort had milder disease than anticipated; nearly 75% of the participants returned home by day 7 and nearly all were home by day 14. ARBs may have a different effect among patients with more severe disease or at a higher dose, according to the investigators. They concluded that although ARBs did not provide benefit in the treatment of COVID-19, the drugs are safe to use in patients with the infection. The results were reported in The BMJ.