The COVID-RASi Trial (COVID-19)

The goal is to determine if RASi with ACEi or ARB, has a beneficial effect in patients with COVID-19 infections, by reducing hospitalizations, ICU admission, ventilator requirement or death.

This is a multi-centre study, conducted in major centres treating COVID-19 patients in-hospital and in various outpatient settings.

Patients admitted to hospital or outpatients that test positive for COVID-19 and meet the inclusion/exclusion criteria will be eligible to participate in this study. All study participants will not be on RASi (ACEi/ARB) treatment at the time of consent. Participants will be randomized to initiation of ACEi vs ARB treatment vs no RASi treatment as part of care for COVID-19 in a 1:1:1 ratio.

The patient will be followed by their physician according to usual clinical care. Sites will complete research-related follow-ups at 24 hours, 7 and 28 days to asssess patient's clinical status, side effects and the achievement of clinical endpoints by telephone interviews. Phone call follow ups will also be conducted at 6 months and 12 months after enrollment in the study.

Inclusion criteria

• Patient with COVID-19 diagnosis with laboratory confirmation within the last 30 days AND
• Age 40 years old or greater if outpatient OR age 18 years old or greater if inpatient (admitted to the hospital) at time of recruitment

Exclusion criteria

• Contraindication to ARB or ACEi, including severe aortic stenosis and angioedema
• Patients who are currently on active treatment with ARB/ACEi
• Known bilateral renal artery stenosis
• Systolic BP ≤90 mmHg
• eGFR<30 ml/min, if not receiving dialysis treatment
• K>5.5 mmol/L on screening laboratory testing
• Recent history of dizziness, vertigo, related to hypotension or orthostatic hypotension, that can lead to contraindication to ACEI/ARBs
• Acute respiratory distress syndrome requiring invasive ventilation