CT visual quantitative evaluation of hypertensive patients with coronavirus disease (COVID-19): Potential influence of angiotensin converting enzyme inhibitors / angiotensin receptor blockers on severity of lung involvement

Clin Exp Hypertens. 2021 May 19;43(4):341-348. doi: 10.1080/10641963.2021.1883051. Epub 2021 Feb 13.


Objective: There is not enough data on the effect of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) on lung involvement in patients with COVID-19 pneumonia and hypertension (HT). Our aim was to compare the lung involvement of the HT patients hospitalized for COVID-19 using ACEIs/ARBs with the patients taking other anti-HT medications.

Methods: : Patients who have a diagnosis of HT among the patients treated for laboratory-confirmed COVID-19 between 31 March 2020 and 28 May 2020 were included in the study. One hundred and twenty-four patients were divided into two as ACEIs/ARBs group (n = 75) and non-ACEIs/ARBs group (n = 49) according to the anti-HT drug used. The chest CT involvement areas of these two groups were evaluated quantitatively by two observers including all lobes, and total severity score (TSS) was calculated. These TSS values were compared between drug groups and clinical groups.

Results: In clinical classification; there were 4 (%3.2) asymptomatic, 5 (4.0%) mild type, 92 (74.1%) common type, 14 (11.3%) severe type, 9 (7.3%) critical type patients. ACEI/ARB group's TSS (mean±SD, 7.74 ± 3.54) was statistically higher than other anti-HT medication group (mean±SD, 4.40 ± 1.89) (p < .001). Likewise, severe-critical clinical type's TSS (mean±SD, 9.17 ± 3.44) was statistically higher than common type (mean±SD, 5.76 ± 3.07) (p < .001). Excellent agreement was established between the two blinded observers in the TSS measurements.

Conclusions: Quantitative evaluation of CT and TSS score can give an idea about the clinical classification of the patient. TSS is higher in ACEI/ARB group than non-ACEIs/ARBs group.

Keywords: Coronavirus disease; computed tomography; covid-19; pneumonia.

MeSH terms

  • Angiotensin Receptor Antagonists / therapeutic use*
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • COVID-19* / diagnosis
  • COVID-19* / epidemiology
  • COVID-19* / physiopathology
  • Correlation of Data
  • Female
  • Humans
  • Hypertension* / drug therapy
  • Hypertension* / epidemiology
  • Lung* / diagnostic imaging
  • Lung* / physiopathology
  • Lung* / virology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Assessment
  • SARS-CoV-2 / isolation & purification
  • Severity of Illness Index
  • Tomography, X-Ray Computed / methods
  • Tomography, X-Ray Computed / statistics & numerical data
  • Turkey / epidemiology


  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors