The Characteristics and Outcomes of Patients Who Make an Emergency Department Visit for Hypertension After Use of a Home or Pharmacy Blood Pressure Device.

STUDY OBJECTIVE: Emergency department (ED) visits for hypertension are rapidly increasing. Hypertension guidelines began recommending use of self-measurement blood pressure (BP) devices in the early 2000s, which could be contributing to the increase. We aim to examine the proportion of ED visits for hypertension that occurred after a BP measurement with a self-measuring device, and the associated outcomes. METHODS: This retrospective observational study included adults who made an ED visit and received a primary diagnosis of hypertension at 1 of 5 community and tertiary hospitals in Ontario, Canada, between April 2010 and March 2011. We categorized ED visits into 4 groups: those made after a home BP reading, a pharmacy reading, as a result of a physician referral, and all others (termed "not documented"). We examined rates of admission to the hospital, ED treatment (administration of antihypertensive medication and prescription provision), and post-ED clinical events (follow-up care, return ED visits, and long-term all-cause mortality) by group. RESULTS: Among 1,508 qualifying patients, median presenting ED BP was 182/97 mm Hg (interquartile range 164 to 200/85 to 109 mm Hg). The percentage of patients who presented to the ED after a reading at home, at a pharmacy, or by physician referral and the remaining patients not documented was 40.9%, 8.3%, 13.3%, and 37.5%, respectively. Overall, 109 patients (7.2%) were admitted to the hospital. The proportion of patients admitted after a home or pharmacy reading, after a physician referral, or who were not documented was 3.1%, 11.9%, and 11.0%, respectively. Two-year mortality rates were 5.4%, 0.0%, 6.5%, and 5.3% for the home, pharmacy, physician referral, and not documented groups, respectively. Among the 92.8% of patients who were discharged from the ED, 11% made another ED visit for hypertension within a year. CONCLUSION: In this study, half of patients with an ED visit that was primarily for hypertension presented after elevated readings on self-measurement devices. Only 3% of these patients were admitted to the hospital.

Effect of whole-body vibration on calcaneal quantitative ultrasound measurements in postmenopausal women: a randomized controlled trial.

The purpose of this study was to examine the effect of whole-body vibration (WBV) on calcaneal quantitative ultrasound (QUS) measurements; which has rarely been examined. We conducted a single-centre, 12-month, randomized controlled trial. 202 postmenopausal women with BMD T score between -1.0 and -2.5, not receiving bone medications, were asked to stand on a 0.3 g WBV platform oscillating at either 90- or 30-Hz for 20 consecutive minutes daily, or to serve as controls. Calcium and vitamin D was provided to all participants. Calcaneal broadband attenuation (BUA), speed of sound, and QUS index were obtained as pre-specified secondary endpoints at baseline and 12 months by using a Hologic Sahara Clinical Bone Sonometer. 12-months of WBV did not improve QUS parameters in any of our analyses. While most of our analyses showed no statistical differences between the WBV groups and the control group, mean calcaneal BUA decreased in the 90-Hz (-0.4 [95% CI -1.9 to 1.2] dB MHz(-1)) and 30-Hz (-0.7 [95% CI -2.3 to 0.8] dB MHz(-1)) WBV groups and increased in the control group (1.3 [95% CI 0.0-2.6] dB MHz(-1)). Decreases in BUA in the 90-, 30-Hz or combined WBV groups were statistically different from the control group in a few of the analyses including all randomized participants, as well as in analyses excluding participants who had missing QUS measurement and those who initiated hormone therapy or were <80% adherent. Although there are consistent trends, not all analyses reached statistical significance. 0.3 g WBV at 90 or 30 Hz prescribed for 20 min daily for 12 months did not improve any QUS parameters, but instead resulted in a statistically significant, yet small, decrease in calcaneal BUA in postmenopausal women in several analyses. These unexpected findings require further investigation.