Air Pollution and Home Blood Pressure: The 2021 Athens Wildfires.

INTRODUCTION: Fine particulate matter with an aerodynamic diameter < 2.5 µm (PM2.5) in the ambient air has been associated with increased blood pressure (BP) levels and new-onset hypertension. However, the association of BP with a sudden upsurge of PM2.5 in extreme conditions has not yet been demonstrated. AIM: To evaluate the association between PM2.5 pollutants the week before, during, and the week after the 2021 wildfires in Athens (Greece) and home BP measurements. METHODS: Home BP measurements were performed, and the readings were transferred to the doctor's office through a telemonitoring system on the patient's Smartphone application. Data from a calibrated, sensor-based PM2.5 monitoring network assessed PM2.5 exposure. RESULTS: PM2.5 pollutants demonstrated a gradual surge while the particle concentration was not different in the selected air pollution measurement stations. A total of 20 consecutive patients with controlled hypertension, mean age 61 ± 9 years, were included in the analysis. For one unit in µg/m3 increase of PM2.5 particle concentration, an average of 2.1 mmHg increment in systolic BP was observed after adjustment for confounders (P = 0.023). CONCLUSIONS: Our findings raise the hypothesis that short-term exposure to raised PM2.5 concentrations in the air appears to be associated with increases in systolic home BP." Telemonitoring systems of home BP recordings may provide important information for the clinical management of hypertensive patients, at least in conditions of major environmental disturbances, such as wildfires.

ACTH vs steroids for the treatment of acute gout in hospitalized patients: a randomized, open label, comparative study.

The management of acute gout in the hospital setting may be challenging since most patients are elderly with multiple unstable comorbidities. However, there are no prospective clinical trials for hospitalized patients with gout to guide optimal management. Evidence indicates that steroids or adrenocorticotropic hormone (ACTH) may be effective and safe therapeutic options for these patients. This study aimed at directly comparing the efficacy and safety of ACTH vs betamethasone for the treatment of gout in hospitalized patients. This is the first prospective clinical trial for hospitalized patients with gout. We designed a randomized, open label study to assess the efficacy and safety of a single intramuscular injection of either ACTH or betamethasone in hospitalized patients with acute gout. Primary efficacy endpoints were the change in intensity of pain as recorded using a Visual Analogue Scale (VAS) at baseline compared to 24 h (ΔVAS24h), and 48 h. Moreover, we assessed safety and effects on the hypothalamic-pituitary-adrenal (HPA) axis, glucose and lipid homeostasis, bone metabolism, electrolytes and renal function. 38 patients were recruited. Both treatments were highly effective. The mean ± SE ΔVAS24h and ΔVAS48h for ACTH was 4.48 ± 0.29 and 5.58 ± 0.26, respectively. The mean ± SE ΔVAS24h and ΔVAS48h for betamethasone was 4.67 ± 0.32 and 5.67 ± 0.28, respectively. Direct comparison between the two groups at 24 h and 48 h did not show statistically significant differences. Both treatments were well tolerated and safe. The effects on all metabolic parameters were mostly minimal and transient for both treatments. However, ACTH may affect less the HPA axis and bone metabolism compared to betamethasone, thus leading to the conclusion that. ACTH and betamethasone are effective and safe for the management of acute gout in hospitalized patients but that ACTH may associate with less disturbance of the HPA axis and bone metabolism. Our data support the use of both drugs as first line treatments for hospitalized patients with gout.Clinical trial registration: ClinicalTrials.gov NCT04306653.