Background Long-term pulmonary sequelae following hospitalization for SARS-CoV-2 pneumonia is largely unclear. The aim of this study was to identify and characterise pulmonary sequelae caused by SARS-CoV-2 pneumonia at 12-month from discharge. Methods In this multicentre, prospective, observational study, patients hospitalised for SARS-CoV-2 pneumonia and without prior diagnosis of structural lung diseases were stratified by maximum ventilatory support (“oxygen only”, “continuous positive airway pressure (CPAP)” and “invasive mechanical ventilation (IMV)”) and followed up at 12 months from discharge. Pulmonary function tests and diffusion capacity for carbon monoxide (DLCO), 6 min walking test, high resolution CT (HRCT) scan, and modified Medical Research Council (mMRC) dyspnea scale were collected. Results Out of 287 patients hospitalized with SARS-CoV-2 pneumonia and followed up at 1 year, DLCO impairment, mainly of mild entity and improved with respect to the 6-month follow-up, was observed more frequently in the “oxygen only” and “IMV” group (53% and 49% of patients, respectively), compared to 29% in the “CPAP” group. Abnormalities at chest HRCT were found in 46%, 65% and 80% of cases in the “oxygen only”, “CPAP” and “IMV” group, respectively. Non-fibrotic interstitial lung abnormalities, in particular reticulations and ground-glass attenuation, were the main finding, while honeycombing was found only in 1% of cases. Older patients and those requiring IMV were at higher risk of developing radiological pulmonary sequelae. Dyspnea evaluated through mMRC scale was reported by 35% of patients with no differences between groups, compared to 29% at 6-month follow-up. Conclusion DLCO alteration and non-fibrotic interstitial lung abnormalities are common after 1 year from hospitalization due to SARS-CoV-2 pneumonia, particularly in older patients requiring higher ventilatory support. Studies with longer follow-ups are needed.

It is increasingly recognised that there are important advantages in studying problems and testing potential solutions in the setting where such problems are most often met. Advantages include the easier acceptance and transfer of results and the development of a research oriented attitude, which in medicine would be expected to increase the quality of care.'2 Isolated systolic hypertension is a common risk factor for cardiovascular and cerebrovascular events in the elderly population.34 Because of the attention focused on it in the mid-1980s we decided that treatment of this condition would be a good subject for a test randomised trial in the setting ofgeneral practice. Care of elderly people forms a large part of general practice, and narrowing the gap between research findings and therapeutic behaviour with respect to hypertension is a priority public health target.57 Based on the promising experience of a collaborative epidemiological study8 we planned a randomised controlled trial, which aimed at recruiting a large number of general practitioners on a voluntary basis. We thought that the trial in general practice could produce information confirmatory or complementary to that expected from other large studies then being conducted or planned in clinical settings.3"9The main aim of the study was to test the hypothesis that treatment of isolated systolic hypertension in elderly people reduces mortality and morbidity from cardiovascular and cerebrovascular causes. The secondary aim was to evaluate the hypotensive effect and safety of the most widely used hypotensive regimens. However, after the feasibility phase of the study had been completed the study was ended. The reasons for the failure of this trial could offer an insight into the relation between research findings and methods and attitudes and performance in general practice. The studyPreparation for the study took about 18 months. During this time we tried to establish active collaboration between the general practitioners and the coordinating group; general practitioners were recruited either through an advertisement in a widely read medical journal or from doctors who had already collaborated in studies organised by our institute. We held central and local meetings to discuss each draft of the protocol and written material was distributed periodically. The forms to be used in the study were tested to ensure that their structure was compatible with use in general practice. Much of the discussion with general practitioners was specifically concerned with the acceptability of the rather complex process of recruiting patients (figure).Of Attendance at follow up at three and six months was 94-6% and 93-9% of expected, respectively. During the follow up period no patient was excluded because of general practitioners' unsatisfactory compliance with the study protocol.Because of the small number ofdoctors participating in the study and the low rate of recruitment (a goal of at least 3500 randomised patients had been planned) the coordinating group decided t...

The prevalence of orthostatic hypotension (OH) in an elderly outpatient population was assessed according to the most common criteria given in the literature. Short-term OH variability and relationships between OH and its known risk factors were also analysed. A sample of 3858 elderly outpatients aged 65 years or more was randomly recruited by 444 Italian general practitioners. The patients' blood pressure (BP) and heart rate were recorded in both lying and standing positions at two visits 7 days apart. Three definitions were used for the identification of OH: (1) a decrease in systolic BP greater than 20 mmHg (SOH); (2) a decrease in both systolic (greater than 20 mmHg) and diastolic (greater than 10 mmHg) BP (SDOH); (3) any decrease in systolic BP associated with symptoms (SyOH). Prevalence figures for SOH were 13.8% at the first and 12.6% at the second visit, and respectively 5.3 and 4.8% for SDOH, 14.1 and 11.8% for SyOH. All the criteria were met by less than 2% of subjects at each visit. The diagnosis of OH was confirmed at both visits in 36.3% of cases for SOH, in 25.7% for SDOH, and in 43.9% for SyOH. Each different OH definition identifies a population subgroup characterized by different sets of risk-factors. The presence and prevalence of OH is difficult to define because different people may be identified by the currently accepted criteria or by the same criterion over a short time.

W e have recently shown that resistant hypertensive patients are characterized by a sympathetic activation and a baroreflex impairment much greater for magnitude than the ones detectable in age-matched nonresistant hypertensives individuals.1 Whether these neuroadrenergic and reflex abnormalities can be reversed by renal denervation has been to date assessed in a case report and 3 studies, 2-5 which have, however, provided conflicting results. Although one study failed to detect any effect of the procedure on muscle sympathetic nerve traffic (MSNA), 3 the other 2 reported a reduction in sympathetic neural discharge which, although statistically significant, was of a modest degree compared with the concomitant marked reduction in blood pressure (BP) values. 4,5 A common limitation of all the above-mentioned studies is that sympathetic activity was assessed only once or, at best, twice after renal denervation thus failing to provide serial information on the behavior of sympathetic nerve traffic over an extended follow-up period after the procedure. Furthermore, lack of sympathetic activity measurements in the earliest post-renal denervation phases did not allow to determine whether the hypothesized sympathetic effects preceded were concomitant to or followed the BP ones. This leaves 2 unanswered key questions: ie, whether the sympathetic neural responses to renal denervation are (1) responsible for its BP-lowering effects and (2) predictors of the antihypertensive response to the intervention.The present study has been undertaken to examine in patients with true resistant hypertension whether and to what extent office and ambulatory BP responses to renal denervation are qualitatively, quantitatively, and temporally related to the MSNA responses, as well as to the modifications of the baroreflex-MSNA sensitivity. This was obtained by serial measurements of the above-mentioned variables according to Abstract-It is still largely unknown whether the neuroadrenergic responses to renal denervation (RD) are involved in its blood pressure (BP)-lowering effects and represent predictors of the BP responses to RD. In 15 treated true resistant hypertensives, we measured before and 15 days, 1, 3, and 6 months after RD clinic, ambulatory and beat-to-beat BP. Measurements included muscle sympathetic nerve traffic (MSNA), spontaneous baroreflex-MSNA sensitivity, and various humoral and metabolic variables. Twelve treated hypertensives served as controls. BP, which was unaffected 15 days after RD, showed a significant decrease during the remaining follow-up period. MSNA and baroreflex did not change at 15-day and 1-month follow-up and showed, respectively, a decrease and a specular increase at 3 and 6 months after RD. No relationship, however, was detected between baseline MSNA and baroreflex, MSNA changes and BP changes. At the 6-month follow-up, the MSNA reduction was similar for magnitude in patients displaying a BP reduction greater or lower the median value. Similarly, the BP reduction detected 6 months after RD was similar ...