Objective Accurate diagnostic testing to identify SARS–CoV-2 infection is critical. Although highly specific, SARS–CoV-2 reverse transcription polymerase chain reaction (RT-PCR), has shown, in clinical practice, to be affected by a non-insignificant proportion of false negative results. The study sought to explore whether the integration of lung ultrasound (LUS) with clinical evaluation is associated with increased sensitivity for the diagnosis of COVID-19 pneumonia, and therefore may facilitate the identification of false negative SARS-CoV-2 RT-PCR results. Methods This prospective cohort study enrolled consecutive adult patients with symptoms potentially related to SARS-CoV-2 infection admitted to the emergency department (ED) of an Italian academic hospital. Immediately after the initial assessment, a LUS evaluation was performed and the likelihood SARS-CoV-2 infection, based on both clinical and LUS findings (“integrated” assessment), was recorded. RT-PCR SARS-CoV-2 detection was subsequently performed. Results We enrolled 228 patients; 107 patients (46.9%) had SARS-CoV-2 infection. Sensitivity and negative predictive value of the clinical-LUS integrated assessment were higher than first RT-PCR [94.4% (95% CI 88.2-97.9), vs. 80.4% (95% CI 71.6-87.4); 95% (95% CI 89.5-98.2), vs. 85.2% (95% CI 78.3-90.6)]. Among the 142 patients who initially had negative RT-PCR, 21 resulted positive at a subsequent molecular test performed within 72 hours. All these false negative cases were correctly identified by the integrated assessment. Conclusion This study suggests that, in patients presenting to the ED with symptoms commonly associated with SARS-CoV-2 infection, the integration of LUS with clinical evaluation has high sensitivity and specificity for COVID-19 pneumonia and it may help to identify false negative results occurring with RT-PCR.

Objectives: The prevalence of hypertensive emergencies and urgencies and of acute hypertension-mediated organ damage (aHMOD) in emergency departments is unknown. Moreover, the predictive value of symptoms, blood pressure (BP) levels and cardiovascular risk factors to suspect the presence of aHMOD is still unclear. The aim of this study was to investigate the prevalence of hypertensive emergencies and hypertensive urgencies in emergency departments and of the relative frequency of subtypes of aHMOD, as well as to assess the clinical variables associated with aHMOD. Methods: We conducted a systematic literature search on PubMed, OVID, and Web of Science from their inception to 22 August 2019. Two independent investigators extracted study-level data for a random-effects meta-analysis. Results: Eight studies were analysed, including 1970 hypertensive emergencies and 4983 hypertensive urgencies. The prevalence of hypertensive emergencies and hypertensive urgencies was 0.3 and 0.9%, respectively [odds ratio for hypertensive urgencies vs. hypertensive emergencies 2.5 (1.4–4.3)]. Pulmonary oedema/heart failure was the most frequent subtype of aHMOD (32%), followed by ischemic stroke (29%), acute coronary syndrome (18%), haemorrhagic stroke (11%), acute aortic syndrome (2%) and hypertensive encephalopathy (2%). No clinically meaningful difference was found for BP levels at presentations. Hypertensive urgency patients were younger than hypertensive emergency patients by 5.4 years and more often complained of nonspecific symptoms and/or headache, whereas specific symptoms were more frequent among hypertensive emergency patients. Conclusion: Hypertensive emergencies and hypertensive urgencies are a frequent cause of access to emergency departments, with hypertensive urgencies being significantly more common. BP levels alone do not reliably predict the presence of aHMOD, which should be suspected according to the presenting signs and symptoms.

ARD is a common phenotype in hypertensive patients, with men showing a markedly higher susceptibility, but office blood pressure values do not appear to be directly associated with aortic root diameter.

The prevalence of orthostatic hypotension (OH) in hypertensive patients ranges from 3 to 26%. Drugs are a common cause of non-neurogenic OH. In the present study, we retrospectively evaluated the medical records of 9242 patients with essential hypertension referred to our Hypertension Unit. We analysed data on supine and standing blood pressure values, age, sex, severity of hypertension and therapeutic associations of drugs, commonly used in the treatment of hypertension. OH was present in 957 patients (10.4%). Drug combinations including α-blockers, centrally acting drugs, non-dihydropyridine calcium-channel blockers and diuretics were associated with OH. These pharmacological associations must be administered with caution, especially in hypertensive patients at high risk of OH (elderly or with severe and uncontrolled hypertension). Angiotensin-receptor blocker (ARB) seems to be not related with OH and may have a potential protective effect on the development of OH.

Periodical education in BP measurement may be required, and this may significantly improve the technique and consequently the accuracy.